Download: Patient Forms & Information

Here you will find the new patient forms, as well as forms we ask current patients to update on a regular basis.

New patients: This is the packet (the 6 PDFs below) you receive as a new patient.

You can review so you know what information will be required, OR you can print/fill out the forms ahead of time (recommended).

Bring your completed forms to your 1st visit, or mail them to ACHC, PO Box 307, Fossil, Oregon 97830.

If you have any questions regarding the forms, please call 541-763-2725 for assistance. Thank you!

1- New patient registration_6 pages_(Forms) (pdf)

2- Release of protected health information_2 pages_(Form) (pdf)

3- Orientation-Gender_1 page_(Form) (pdf)

4- Sliding Fee Scale 2020_4 pages_(Form) (pdf)

5- Privacy-HIPPA_12 pages_(Information) (pdf)

6- my chart & script refill_2 pages_(Information) (pdf)