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Patient Forms for Children

Children Under 18 Years Old

Alternate Caretaker Authorization for Minor Patient

Kinship Care Authorization for Minor Patient

Unaccompanied Minor Authorization

 

Dental Forms
Consent to Dental Treatment

Dental Health History 

 

Insurance Benefit and Payment Obligation Form

Sliding Fee Discount Program Application

 

Not finding the form you need? A full list of Unity Care NW forms can be found here.

  • Unity Care NW
Bellingham

Medical & Children’s Dental Services

220 Unity Street
Bellingham, WA 98225

Open in Google Maps

phone: (360) 676-6177
toll-free: (877) 235-6850
after hours: (800) 259-3565
fax: (360) 671-3574

Hours:
7:45 AM – 6:00 PM Mon – Fri
7:45 AM – 5:00 PM Sat
Closed for lunch on Saturdays from 12:30pm - 1:30pm
Dental closed Thursdays from 7:45 AM – 8:45 AM

Adult Dental, Behavioral Health, Donations, and Administration

1616 Cornwall Ave.
Ste. 205
Bellingham, WA 98225

Open in Google Maps

phone: (360) 676-6177
toll-free: (877) 235-6850
fax: (360) 671-3574
Behavioral Health 24-hour Crisis Line: (800) 584-3578

Hours:
7:45 AM – 6:00 PM Mon – Fri
Dental closed Thursdays from 7:45 AM – 8:45 AM

In-House Pharmacy

218 Unity Street
Bellingham, WA 98225

Open in Google Maps

phone: (360) 752-7406
toll-free: (877) 235-6850
fax: (360) 312-5238

Pharmacy Hours:
8:30 AM – 6 PM Mon – Fri
8:30 AM – 5:00 PM Sat
12:30 PM – 1:00 PM closed for lunch, Saturdays only

Quest Diagnostics Lab

220 Unity Street (downstairs)
Bellingham, WA 98225

Open in Google Maps

phone: (360) 733-3888

Hours:
8:00 AM – 5:00 PM Mon – Fri
Closed 11:50 PM - 1:00 PM for lunch

8:00 AM - 4:15 PM Sat
Closed 12:20 PM - 1:30 PM for lunch

HRSA-hit-Seal

ACE-Silver-S

Open in Google Maps

HRSA-pcmh-Seal

Open in Google Maps

Ferndale

Medical, Dental, and Behavioral Health Services

6060 Portal Way
Ferndale, WA 98248

Open in Google Maps

phone: (360) 676-6177
toll-free: (877) 235-6850
after hours: (800) 259-3565
fax: (360) 383-0808
Behavioral Health 24-hour Crisis Line: (800) 584-3578

Hours:
7:45 AM – 6:00 PM Mon – Fri
Dental closed Thursdays from 7:45 AM – 8:45 AM

In-House Pharmacy

6060 Portal Way
Ferndale, WA 98248

Open in Google Maps

phone: (360) 752-7408
fax: (360) 594-3440

Pharmacy Hours:
8:30 AM – 6:00 PM Mon – Fri

Quest Diagnostics Lab

6060 Portal Way
Ferndale, WA 98248

Open in Google Maps

phone: (360) 296-7199

Hours:
8:30 AM – 5:15 PM Mon – Fri
Closed for lunch from 12:50 - 2:00 pm

Services
  • Medical
  • Dental
  • Pharmacy
  • Children’s Services
  • Behavioral Health
  • Communicable Disease
  • Quest Diagnostics Lab
  • Population Health
About Us
  • Learn About Us
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I Want To
  • View Health Education Videos
  • Make a Donation
  • Refill a Prescription
  • Online Bill Pay
  • Sign Up for Insurance
  • Sign up for the Patient Portal
  • Sign Up for Newsletters
  • Stories
  • Apply for a Job

© 2023 Unity Care NW | Privacy Policy | Quality Improvement

Unity Care NW (UCNW) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (360) 676-6177.

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (360) 676-6177.

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