Are you interested in becoming a new patient?
What must I do?To begin the process to become a patient at any Curry Health Network location, we ask that you submit a New Patient Questionnaire and an Authorization to Disclose Healthcare Information form.
Why?The New Patient Questionnaire helps us better match you with a Provider that meets your needs, and the Authorization to Disclose Healthcare Information allows our professional staff to receive your medical records from your former physicians in order to better provide your care.
How do I get the forms?You may obtain these forms by phoning our Patient Intake Coordinator at 541.412.2063, or by downloading them by clicking on the links below:
New Patient Questionnaire
New Pediatric Patient Questionnaire
Authorization to Disclose Healthcare Information
How do I send you the completed forms?After the Questionnaire and Authorization forms are complete, you may:
fax them to 541.412.2083
mail them to: Curry Health Network, ATTN: Patient Intake Coordinator, 500 5th St., Brookings, OR 97415
scan and email (encrypted and secure) via our online form