NUNM Health Centers appreciate your patience as we adapt to changing needs during the COVID-19 pandemic. Your health is our priority.
NUNM Helfgott Clinic
New Patient Forms
NUNM patients will need to complete a number of forms to become an established patient. These forms can be downloaded via the links available below:
We ask that each new patient fill out a registration packet that reflects their age group.
- New Patient Packet – Adult: English | Spanish
- New Patient Packet – Adolescent: English | Spanish
- New Patient Packet – Infant/Child: English | Spanish
Consents For Care
These individual consents are a part of the New Patient Packet. Patients will be asked to sign these consent forms each time they are updated.
- General Consent for Treatment: English | Spanish
- Financial Policy: English | Spanish
- Patient Rights & Responsibilities: English | Spanish
- HIPAA Notice of Privacy Practices: English | Spanish
- Compassionate Care Program Application (optional): English | Spanish
Other Health Center Documents
Based upon your care needs, you may be asked to review and/or sign these additional documents: