Patient Forms

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

Below you can download all the new patient forms in one packet or just one individual form. Not sure which patient forms you need?  Reach out to your NHC clinic or call (503) 848-5861 for support.

New Patient Packets

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]

Authorization to Release Medical Information [English] [Spanish]

Authorization to Release Dental Information [English] [Spanish]