Welcome to the RCMS family! It is our mission to provide the highest quality healthcare to all of our patients. It is important that all forms in your file are accurate and up to date. Please help us keep your records up to date by reporting any recent changes. First time patients, speed up the registration process by filling out these forms and bringing them to your first appointment.

Patient Registration

Registration Forms

If you are a new patient, or need to update your information, please fill out the appropriate Patient Registration form and bring it with you to your appointment. También está en español.
Adults (18+ years of age)
Minors (under 18 years of age)

First appointment?

Please also complete the patient Medical History form.

Parent or Guardian Consent to Treat Minors

By law, any child under the age of 18 years old cannot be seen by a doctor without consent from a parent or legal guardian. This form gives permission to any RCMS Provider to treat the minor in accordance with the provisions of Family Code Section 6910.

Release of Information

Incoming Records

Authorize the release of your records
​from another facility to RCMS.

Outgoing Records

Authorize the release of your records
​from RCMS to another facility.

​Financial Assistance

To be eligible, please provide proof of income within 30 days of submitting your application. Acceptable forms include:
  • W-2 form
  • Last year’s income tax return
  • Most recent pay check stub
  • Unemployment check stub
  • Notification of Benefit for disability income
  • Social Security payment letter or bank statement showing proof of direct deposit of Social Security income
  • If self-employed, either prior year’s Schedule C income statement or quarterly profit and loss statement
  • Worker’s Compensation stub or proof of direct deposit
  • Signed personal letter stating declaration of income such as income from boarders, odd jobs, or assistance from charity, family for friends
If you are unable to provide RCMS with one of the approved forms of income documentation, please call 707-882-2189 for assistance.
Eligible patients in our service area (Elk to Timber Cove) are eligible to apply for the Sliding Scale Discount program. To apply fill out the Patient Financial Screening Form below: