Patient Forms for New Children

Patients Under 18 Years Old

Registration Form

Patient Rights and Responsibilities

Notice of Privacy Practices

Alternate Caret aker Authorization for Minor Patient

K inship Care Authorization for Minor Patient

Unaccompanied Minor Authorization

Demographics Form – Children

Dental Forms
C onsent to D ental Treatment
Dental Health History

Acknowledgements and Consent

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.