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.

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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.

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Your Rights as a Client

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

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Acknowledgment of Notice of Privacy Practices

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

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Board of Directors Voter Registration Form

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

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Client Feedback Form

Please click here to submit a feedback form or call the Quality Improvement Department at (707) 296-2500.

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