Northern Valley Indian Health

NVIH Primary Content

Click on the appropriate forms below to download a registration packet.

• Medical Forms
  • Patient Registration Packet
  • Patient Registration Packet (Spanish)
• Dental Forms
  • Adult/Minor Registration Packet
  • Adult/Minor Registration Packet (Spanish)
• Mobile Dental Clinic Forms
  • English Registration Packet
  • Spanish Registration Packet
• Behavioral Health Forms
  • Behavioral Health Registration Packet
• Minor Consent Forms
  • Authorization to Seek Medical Care
  • Permission to Treat a Dental Minor Without a Parent or Guardian present
  • Caregiver's Authorization Affidavit
  • (CILS) What is an Indian Custodian?
  • Documentation of Self-Sufficient Minor Status
• Spanish versions/Versiónes en Español
  • Autórizacion Para Buscar Atención Medica
  • Permiso Para Tratar a un Paciente Dental Sin un Padre/Tutor
  • Declaración Jurada con Autorizatión para el Cuidador
  • Documentación sobre condición de autosuficiencia del menor
  • Autorización para el tratamiento médico de un menor sin presencia del padre/madre o tutor