Patient Forms
Select a Tab to Find a Your Form(s)
- New Patient Packet This completed packet needs to be returned back to Clinch River Health Services one week prior to your first appointment.
- NEW PATIENT INFORMATION- BEHAVIORAL HEALTH
- New Patient Packet (Spanish Version)
- Patient Registration Form
- Patient Registration (Spanish Version)
- General Consent Form
- Behavioral Health Consent Form
- General Consent Form (Spanish Version)
- Authorization for Use Disclosure Personal Health Information
- Authorization for Use Disclosure Personal Health Information (Spanish Version)
- Patient Rights and Responsibilities
- Patient Rights and Responsibilities (Spanish Version)
Other Forms:
Our Hours:
- Monday: 8:30 a.m.- 8 p.m.
- Tuesday: 10:45 a.m.- 5 p.m.
- Wednesday: 8:30 a.m.- 5 p.m.
- Thursday: 8:30 a.m.- 8 p.m.
- Friday: 8:30 a.m.- 5 p.m.
- Saturday: 8:30 a.m.- 12 Noon