Patient Forms

Fill out forms online to save time on your next visit!

Primary Care Registration Forms

Primary Care Registration >>

Dental Forms

Patient Registration Form >>

School-Based Health Forms

Consent Form >>
Enhanced Referral Services Form >>

Pediatrics Forms

2-Month >>
4-Month >>
6-Month >>
8-Month >>
9-Month >>
10-Month >>
12-Month >>
14-Month >>
16-Month >>
18-Month >>
20-Month >>
22-Month >>
24-Month >>
27-Month >>
30-Month >>
33-Month >>
36-Month >>
42-Month >>
48-Month >>
54-Month >>
60-Month >>

Pediatric Behavioral Health Intake Form>>
Pediatric Behavioral Health Intake – 2nd Parent Informant>>
Pediatric Behavioral Health Intake—Teacher Informant>>

Covid-19 Forms

Covid Testing Patient Registration Form >>

Behavioral Health Forms

BH Mental Health Intake Form >>
BH Consumer Acknowledgments and Consent to Treatment >>

BH Notice of Privacy Practices – English
BH Notice of Privacy Practices – Spanish

BH Client Treatment Client Notifications – English
BH Client Treatment Client Notifications – Spanish

Patient Concern Forms

Patient Concern Form >>

Pharmacy Forms

SimpleScripts – Patient Agreement Form >>

Release/Disclosure of Medical Information Forms

Authorization to Release Medical Information to Outside Entity >>
Authorization to Release Medical Information to Rogue Community Health >>
Consent to Use or Disclose Medical Info >>

Consent Forms

Consent to Receive Appointment Reminders and Other Healthcare Communications >>

Vaccination Consent Form >>

HIPPA Information – Notice of Privacy Policy

English >>
Spanish >>