Start your journey to wellness with ease by completing your new patient forms for your first visit to NUNM Health Centers. Whether you’re seeing a naturopathic doctor, acupuncturist, or other provider, filling out these forms in advance helps us better understand your health needs and streamlines your check-in process. Get started today and take the first step toward personalized, integrative care.
Registration Packets
If you’re a new patient to NUNM Health Centers, or if we haven’t seen you in more than 3 years, we will need a complete and updated patient registration packet. This packet includes required demographic and insurance information as well as a comprehensive health history. These documents must be completed BEFORE we can schedule your appointment. Please allow 5 business days to process your application.
The Registration form contains space to attach information about your health history and medications. You will also be asked to provide photos of your insurance card and ID. These photos can be taken by phone camera or scanned and attached to the document. This form contains required fields which are outlined in red. The form can’t be submitted until all required fields are filled.
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:
- 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:
- Your Information, Yours Rights, Our Responsibility: English | Spanish
- Authorization to Disclose Protected Health Information –
- Limited Registration: English | Spanish
- Patient Authorization for Family & Friends: English | Spanish
We are here if you have questions about these documents. Give our information center a call if you need assistance: 503.552.1551.
NUNM Health Centers complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. NUNM Health Centers does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Read more about NUNM’s Non Discrimination Notice: English | Spanish
Need Help?
We are here if you have questions about these documents. Give our information center a call if you need assistance: 503.552.1551
NUNM Health Centers complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. NUNM Health Centers does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Read more about NUNM’s Non Discrimination Notice: English | Spanish