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    • Patient Portal
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    • Patient Education & Self-Management
    • Frequently Asked Questions
  • Contact Us
Menu
  • Home
  • About Us
  • Services
  • For Patients
    • Patient Portal
    • Patient Forms
    • Insurance Info
    • Sliding Fee Discount Program
    • Patient Education & Self-Management
    • Frequently Asked Questions
  • Contact Us

Patient Forms

You can complete your patient forms in advance, or complete the forms provided by our front desk representatives during your check-in process. To download the patient forms, click on the links below.

New Patient Forms
  • Patient Intake Form
  • HIPAA Information and Consent Form
  • Consent for Disclosure and/or Release of Confidential Information
  • Physician Orders for Life-Sustaining Treatment
  • DHCS Staying Healthy Assessment Adult
  • DHCS Staying Healthy Assessment Senior
Existing Patient Forms
  • Patient Intake Form
  • DHCS Staying Healthy Assessment Adult
  • DHCS Staying Healthy Assessment Senior
Behavioral Health Forms
  • Behavioral Health Referral Form
Pediatric Forms
  • DHCS Staying Healthy Assessment 0-6 Months
  • DHCS Staying Healthy Assessment 7-12 Months
  • Vaccines for Children Program Form

Information for Patients

Notice of Privacy Practices
  • Notice of Privacy Practices (English)
  • Notice of Privacy Practices (Spanish)
  • Notice of Privacy Practices (Vietnamese)
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Our Organization

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Patient Support

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  • Patient Forms
  • Insurance

Resources

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  • Frequently Asked Questions
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NH Health Center

7761 Garden Grove Blvd.
Garden Grove CA 92841

Monday – Friday: 9AM-6PM
Saturday: 9AM-1PM
Sunday: Closed

  • After Hours Care Information
  • 714.898.8888

© 2021 Nhan Hoa Comprehensive Health Care Clinic, Inc. All rights reserved.