Client Forms

The forms below help EHP’s medical staff understand your environmental conditions and health concerns. To expedite your office visit, EHP encourages clients to print and complete forms at home and bring them to your appointment (along with any medical records or other available documentation).

EHP’s Nurse Practitioner can provide you with additional information about which forms are needed for your particular situation.

Our forms are also available in Spanish:

Please direct any questions to Jessa Chabeau, Case Manager jchabeau [at] environmentalhealthproject.org or 724-260-5504.

Photo courtesy of WV Host Farms Program. Drilling truck convoy. December 31, 2012. Provided by The FracTracker Alliance on FracTracker.org.