The Yakima Pediatric clinic 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.
In order to save you time, we ask that you contact the office at 509-575-0114 to register your child, prior to completing the registration paperwork. Thank you.
In order to have easy access to forms that have been completed and signed by your provider in the future, we highly encourage you to sign up for our Patient Portal. Please ask a member of our Reception Team for assistance!
Patient Registration Form – English | Spanish
Online Patient Registration Form – English | Spanish
(no PDF reader required)
Authorization to Release Patient Health Information to CHCW
Authorization to Release Patient Health Information From CHCW to External Entity