Patient Forms

Please download and complete your patient forms before your first appointment at NHC. Completing your forms in advance helps us manage clinic capacity and avoid high appointment wait times.

Not sure which patient form is right for you?  Reach out to your NHC clinic or call (503) 848-5861 for support.

New Patient Forms

Adult Medical Registration Packets

Adult - English  Spanish

Pediatric Medical Registration Packets

Pediatric 0 to 2 - English  Spanish

Pediatric 3 to 11 - English  Spanish

Pediatric 12 to 17 - English  Spanish

Dental Registration Packets

Pediatric - English  Spanish

Adult - English  Spanish

Pediatric (0-17) Forms

Ages 0-2

Registration Form [English] [Spanish]

Combined Consent [English] [Spanish]

PHI Permissions [English [Spanish]

Dental History [English] [Spanish]

Pediatric Health History [English] [Spanish]

Ages 3-11

Registration Form [English] [Spanish]

Combined Consent [English] [Spanish]

PHI Permissions [English [Spanish]

Dental History [English] [Spanish]

Pediatric Health History [English] [Spanish]

Ages 12-17

Registration Form [English] [Spanish]

Combined Consent [English] [Spanish]

PHI Permissions [English [Spanish]

Dental History [English] [Spanish]

PHQ9 Form [English] [Spanish]

Pediatric Health History [English] [Spanish]

Adult (18+) Forms

Registration Form [English] [Spanish]

PHQ9 Form [English] [Spanish]

PHI Permissions [English [Spanish]

 

Health History [English] [Spanish]

Dental History [English] [Spanish]

SBIRT Form [English] [Spanish]

Combined Consent [English] [Spanish]