Find patient forms, applications, and resources for Nehalem Bay Health Center & Pharmacy. Some forms can be completed before your appointment to help save time when you arrive. If you have questions or need help with a form, please call us or ask a staff member during your visit.
Call: 1-800-368-5182
If you are new to Nehalem Bay Health Center & Pharmacy, please complete the forms requested by our team before your first appointment.
Complete this form if you are a new patient or if NBHCP staff ask you to update your registration information.
Complete this form if you are a new patient or if NBHCP staff ask you to update your registration information.
Complete this form before your first medical appointment so your care team can better understand your health history, medications, allergies, and health concerns.
Review and sign this form to acknowledge financial responsibility for services that may not be covered by insurance or another health plan.
Review and sign this form to acknowledge how NBHCP may use and disclose health information for care, treatment, payment, and clinic operations.
Complete this form if you want NBHCP to verbally share information about your care with a family member, caregiver, or another person you choose.
This document explains patient rights, including respectful care, privacy, confidentiality, interpreter services, access to records, and understanding care decisions, along with patient responsibilities.
Use these forms to request medical records or authorize records to be shared.
Complete this form to authorize medical records to be released to NBHCP or from NBHCP to another healthcare facility, provider, or person.
If you have a dental appointment, please complete the forms requested by our dental team before your visit.
Complete this form before your dental appointment so our dental team can review your medical history, medications, allergies, and health needs.
Complete this form to share information about your dental history, oral health concerns, and dental care goals.