Community Members Wellness Center Registration

Please complete the following form in order to be verified and granted access to OCHN's Wellness Center. All information provided in this form is confidential and used only for OCHN Wellness Center registration purposes.

Please provide your public mental health ID number to verify that you are receiving services through OCHN's network.

Type "NA" if you are a guardian or support professional.

If yes, they must also complete the registration process.

Select your provider from the drop down list.

Type your current provider below if they are not listed in the selection above.

Upload a signed copy of the waiver here. If you are unable to upload the waiver, bring a signed hard copy to OCHN.

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