New Patients

New Patient Forms

All new patient forms have been consolidated into one easy to use packet. Available in both English and Spanish.

Click here for the English New Patient Packet
Click here for the School-Based Health Center New Patient Packet		 Click here for the Spanish New Patient Packet
The packet includes:

    • Patient Registration Form
    • Health History Form
    • Patient Demographics
    • Assignment of Benefits
    • Income Verification Form
    • Acknowledgement and Consent
    • Notice of Privacy Practices
    • Patient Agreement Form
    • Consent to disclose medical records
 El paquete incluye:

    • Asignación de Beneficios
    • Formulario de Verificación de Ingresos
    • Reconocimiento y Consentimiento
    • Aviso de prácticas de privacidad
    • Formulario de Acuerdo del Paciente
    • El consentimiento para revelar los registros médicos
Phone:   541-851-8110
Fax:   541-851-8114

Email Inquiries

Mailing address:   2074 S 6th St Klamath Falls, OR 97601

All Locations
Klamath Health Partnership, Inc. is an FTCA deemed organization.
For more information about FTCA click here.

Click here to download our notice of non-discrimination.