ELLENSBURG CLINIC FORMS
The Ellensburg Clinic Care forms on this page are provided in Adobe PDF format, please download the form(s) you need, fill it in and return it.
If you need Adobe Reader to open the forms you can download it here.
Please ask a member of our Reception Team for assistance at (509) 962-1414
Adult Patient Registration Form: English | Spanish
Online Adult Patient Form: English | Spanish
(no PDF reader required)
Pediatrics Patient Registration: English | Spanish
Teen Patient Registration: English | Spanish
Additional Forms
Authorization to Release Patient Health Information to CHCW
Authorization to Release Patient Health Information From CHCW to External Entity
Personal Family History Form: English | Spanish