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 estáen español.
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.
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:
