Patient Forms

Primary Care Registration Forms

Primary Care Registration >>

Sliding Fee Scale Application Forms

Sliding Fee Scale Application (Only Complete After Filing Patient Registration Form)

Dental Forms

Patient Registration Form >>

School-Based Health Forms

Consent Form >>
Student Needs Form English/Spanish

Pediatrics Forms

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 >>

Release/Disclosure of Medical Information Forms

Authorization to Release Medical Information to Outside Entity

Autorización Para Divulgar Información A Una Entidad Externa

Authorization to Release Medical Information to Rogue Community Health

Autorización Para Obtener Información Médica

Consent to Use or Disclose Medical Info >>

Consent Forms

Vaccination Consent Form >>

HIPPA Information – Notice of Privacy Policy

English >>
Spanish >>