Links & Forms

The following are provided for your convenience. If you need any forms mailed to you, please fill out our Contact Us form or call our office at 509-925-7600 (local) or 855-426-9646 (toll free).

Si necesita formularios por correo, llene nuestro formulario de contacto o llame a nuestra oficina al 509-925-7600 (local) o al 855-426-9646 (sin cargo).

ONLINE PATIENT REGISTRATION
Click on the “Online Registration” link above to register for the first time. If you have already registered and need to modify any of your information, you may click on the same link but choose the “Existing Patient” option. If you would like to complete the registration form in another language, use the drop down menu at the bottom of the page to select your preferred language.

Si desea completar el formulario de inscripción en español, use el menú desplegable en la parte inferior de la página de registro.

If you prefer a paper form, please download the New Patient Registration Form fill it out, and fax to 509-925-9646. You can also mail or hand deliver to:

Northwest Oral Health Outreach
Attn: Patient Records
1206 N. Dolarway Rd, Suite 208
Ellensburg, WA 98926

 
Records Release Form
If you want your records transferred from your current dental provider to Northwest Oral Health Outreach, please fill out the Records Release Form and give it to your current dental provider. They will send us a copy of the records you authorize to be released.

Si desea que sus registros sean transferidos de su proveedor dental actual a Northwest Oral Health Outreach, por favor llene el Formulario de Liberación de Registros y dárselo a su proveedor dental actual. Nos enviarán una copia de los registros que usted autoriza para ser liberados.

Click here to read our Privacy Policy.

Haga clic aquí para leer nuestro Política de Privacidad.

 

Membership Program
Click to sign up or manage membership. Haga click en para registrarse o administrar la suscripción.

Providing access to care to those that need it most.