Forms
For your convenience, we have provided the following forms:
Registration Packet
Download our registration packet using the link below. You may then bring it to the clinic or email it to debra.rowles@nhcc.care.
Medical Records must be received from your child’s previous doctor before we schedule the first appointment. It may take up to a week or longer for us to get the records from your physician.
Medical Authorization
Form that names emergency contacts and anyone you authorize to get care for the child and make decisions regarding the care provided.
Newborn History Form (Birth Mother)
If the birth mother is bringing the child for care, this form provides information about the newborn’s health history and mother’s health history.
Newborn History Form (Other Caregiver)
If someone other than the birth mother is bringing the child for care, this form provides information about the newborn’s health history and mother’s health history.
