Client Forms

New Client Registration Form

Are you a new client at UIHS? Please fill out this form, print it, and bring it to our front desk.

Go>>

Family Intake Screening Form

If you are bringing a child or children to UIHS, please fill out this form and bring it to our front desk.

Go>>

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can access this information.

Go>>

Acknowledgment of Notice of Privacy Practices

Please sign, print, and return this form to our office.

Go>>

Board of Directors Voter Registration Form

This form is to register for voting in the election for the Board of Directors of UIHS.

Go>>

Client Feedback Form

Please click her to fill out this form online or download from the provided link and return the completed form to any UIHS Clinic for review. Or call the Quality Improvement Department at (707) 296-2501. Please be aware that the fillable form is currently under construction.

Go>>