• Union County General Hospital
  • 300 Wilson Street
  • Clayton, New Mexico 88415
  • Phone: 575-374-7012
  • info@ucgh.net

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Clinic Forms and Policies

Union County Health Center would like you to get the most out of your visit. To make sure your appointment runs smoothly, please review our patient forms and policies page. You will find:

Appointment forms

For your appointment

  • Arrive early to fill out paperwork.
  • Provide your date of birth, address, phone numbers, social security number, and employer.
  • Bring your medications to your appointment.
  • Provide current and accurate information.
  • Bring your insurance cards.

Mail-in Prescriptions

  • Bring your refill form with the patient portion filled out.
  • Provide the fax number, address and phone numbers for the mail-in pharmacy you use.

Prescription Refills

  • Please have all information when you call for a refill.
  • Date of birth.
  • Name of medication, dose and reason for taking the medication.

Medical Test Results

  • Please allow 7-10 business days for your results.
  • Please make a follow up appointment with your provider to go over any test results, 575.374.2273.
  • Medical Records Request.

Medical Record Request

  • Please fill out a record release form.
  • Allow 10 business days to complete your request.
  • Provide the recipient’s fax number, phone number and address, if applicable, with your request information.


  • After three no shows in a three-month time period, patients are required to make same day appointments.
  • Patients are responsible for payment when inaccurate information is presented.
  • Appointments should be canceled 24 hours prior to a scheduled appointment time.
  • A patient is asked to reschedule appointments if you are more than 15 minutes late.