Patient Forms
Patient Registration Forms
- Acknowledgment of Receipt of Notice of Privacy Practices
- Advanced Directive Acknowledgement
- Authorization to Furnish Information / Assignment of Benefits
- Notice of Privacy Practices
- Patient Registration Update Form
- Patient Rights and Responsibilities
- Privacy Act of 1974 – Statement of Maintenance of Health Records
- Registration Instructions
- Complete Patient Registration Packet
Other Forms
Administration
3949 S 6th Street
Klamath Falls, OR 97603
(541) 882-1487
Wellness Center
330 Chiloquin Boulevard
Chiloquin, OR 97624
(541) 882-1487
Youth & Family Guidance Center
6000 New Way
Klamath Falls, OR 97601
(541) 884-1841
Useful Links
Patient Services
Hours
Mon-Fri
7:30am- 4:00pm
SAT -SUN
Closed
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