Forms & Policies

New Patient

Within Siletz Community Health Clinic’s (SCHC) limit of available health services, we serve Native Americans and Non-Natives.

Eligible Native Americans can receive SCHC services at no cost after insurance, if any. Non-Federally recognized Native Americans and Non-Natives are responsible for the cost of services not covered by insurance.

You can read our Patient Guide Brochure for an overview of services and additional information.

Becoming a Patient

You will need to:

Fill out a new patient registration packet.
Provide photo identification such as your driver’s license or tribal enrollment identification card. If patient is a minor this will be waived.
Provide a birth record or certificate of live birth for minors and tribal descendant adults.
Provide a Social Security Card or number.
Provide insurance documentation cards.
Submit the registration packet and documentation to the Patient Registration Specialists’ at medical reception

You may submit your registration with required documents:

In person to our Patient Registrations Specialists’ located at our medical reception area
By Fax: 541-444-9695
By Mail: Attn: Medical Records PO Box 320, Siletz, OR 97380
By Email: medicalrecords@ctsi.nsn.us – note email is not secure, send at your own discretion.

To make or cancel a medical appointment, call 800-648-0449 or 541-444-1030, Opt. 1. We ask you to arrive 15 minutes early to check in. You will be asked if your contact information is current at each visit. If you are late 10 minutes or longer you will be asked to reschedule your appointment.

New Patient Registration Packet