Fill out this form to register as a Northwest Health Services' patient. We'll need patient, billing, insurance and household information.

INTAKE FORM

Northwest Health Services Discount Program is based on a sliding fee which includes medical, dental, behavioral health & pharmacy services. Apply today!

DISCOUNT PROGRAM INFO

DISCOUNT PROGRAM APPLICATION

Review your rights as a patient of Northwest Health

PATIENT RIGHTS

Print your paperwork and forms for a behavioral health appointment ahead of time! Please note that these forms usually take 30 minutes or so to complete. Thank you.

BH Patient Expectations and Consent Form

Behavioral Health Adult History Form

Behavioral Health Child History Form

Behavioral Health Adolescents 13-17