Patient Paperwork

New to Nehalem Bay Health Center? Welcome!

New Patient Paperwork - to save time, you can download the new patient paperwork, fill it out ahead of time, print it, and bring it in with you for your appointment.

• New Patient Registration Form (fillable PDF)

• Formulario de Registro de Paciente Nuevo (PDF rellenable)

Sliding Fee Scale available:  Nehalem Bay Health Center provides care, on a sliding scale, regardless of the ability to pay. For more information on how to apply, please ask at the front desk. You can download the sliding fee guidelines and application by following the links below. 

Sliding Fee Scale paperwork:

• Sliding Fee Income Guidelines

• Sliding Fee Application (fillable PDF)

• Pautas de Ingresos de la Escala Móvil

• Solicitud de la tarifa móvil (PDF rellenable)

MyChart - Access your health record online

Have you signed up for MyChart yet? Learn more here: Nehalem Bay Health Center MyChart

Medical Records Release Forms:

• Authorization to Release Medical Records (fillable PDF)

• Autorización para la divulgación de registros médicos (PDF rellenable)

The Medical Records Release Forms can be turned in at the front desk, mailed (to PO Box 176, Wheeler, OR 97147 to the attention of Medical Records), or faxed to 844‐712‐3001. Depending on the type of request, we typically have up to 30 days to respond (but we do our best to get them out sooner). Patients who want to see their records can also sign up for MyChart.

Your feedback is important to us:

If you had an unsatisfactory experience at Nehalem Bay Health Center or Nehalem Bay Pharmacy, we would like to hear about it.

• Patient/Customer Grievance Form (fillable PDF)

• Formulario de queja del paciente/cliente (PDF rellenable)