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

Pediatric History Form: English | Spanish

Surgeries Form: English  | Spanish