REDWOOD COAST MEDICAL SERVICES
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Patient Forms

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)
English
Spanish

Minors (under 18 years of age)
English
Spanish

First appointment?

Please complete the patient Medical History form.
Medical History

Financial Assistance

Sliding Fee Discount - English
Sliding Fee Discount - Spanish

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.
Permission to treat minor

Release of Information

Incoming Records

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

Outgoing Records

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

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  • Home
  • For Patients
    • Make an Appointment
    • Patient Forms
    • Financial Assistance
    • COVID-19
  • Services
    • Primary Care
    • Urgent Care
    • Dental Care
    • Women's Health
    • Behavioral Health
    • On Site Pharmacy
    • Addiction Treatment
    • Outreach & Enrollment
    • Visiting Nurse/Palliative Care
  • ABOUT
    • Contact Us
    • Leadership
    • Providers
    • Board of Directors
    • Privacy Policy
    • Donate >
      • IRA Qualified Charitable Distribution
  • Careers
  • News