Patient Portal
If you are a patient of NKN Student Health & Wellness Center, you can sign up for MyChart, which is an easy way to access your personal health information online and communicate with your health care team. Sign up for MyChart at your next appointment, or ask the staff at NKN Student Health & Wellness Center.
If you are already signed up, you can login and access here:
MyChart Login
Patient Satisfaction Survey: Students between the ages of 12 and 19 who visit NKN Student Health & Wellness Center may be asked to complete an anonymous survey after their visit. The survey asks about the student’s satisfaction and experience at the health center, as well as some general questions about their physical and mental health status. Students can refuse to take the survey, and this will not affect their ability to get care at NKN Student Health & Wellness Center. To see a copy of the survey or if you have questions about the survey, please contact the School Based Health Center State Program Office at sbhc.program@dhsoha.state.or.us
New Patient Forms
To save time, you can download the new patient paperwork, fill it out ahead of time, print it, and bring it in with you for your appointment.
Forms in English
Formularios en Español
- NEW PATIENT REGISTRATION
- CONSENT TO TREAT FORM - STUDENT
- CONSENT TO TREAT FORM - ADULT
- HIPAA FORM
- RELEASE OF VERBAL MEDICAL INFORMATION FORM
- NEW PATIENT HEALTH HISTORY FORM - STUDENT
- NEW PATIENT HEALTH HISTORY FORM - ADULT
- NOTICE OF PRIVACY PRACTICES
- NKN SCHOOL SPORTS PHYSICAL FORM
- MEDICAL RECORDS RELEASE FORM
- PATIENT COMPLAINT/GRIEVANCE FORM
- OPT-OUT FORM
- FORMULARIO DE REGISTRO DE NUEVO PACIENTE
- CONSENTIMIENTO PARA TRATAR LA FORMA - ESTUDIANTE
- CONSENTIMIENTO PARA TRATAR LA FORMA - ADULTOS
- FORMULARIO HIPAA
- FORMULARIO DE DIVULGACIÓN DE INFORMACIÓN MÉDICA VERBAL
- FORMULARIO DE HISTORIAL DE SALUD DE PACIENTES NUEVOS - ESTUDIANTE
- FORMULARIO DE HISTORIAL MÉDICO DE PACIENTES NUEVOS - ADULTOS
- AVISO DE PRÁCTICAS DE PRIVACIDAD
- FORMULARIO DE EXAMEN FISICO DE DEPORTES ESCOLARES DE NKN
- FORMULARIO DE DIVULGACIÓN DE REGISTROS MÉDICOS
- FORMULARIO DE QUEJA / RECLAMO DEL PACIENTE
- FORMULARIO DE BAJA VOLUNTARIA
Vaccination Forms
If you are scheduled for immunizations during your visit, you can save time by downloading and filling out the vaccination checklists in advance, then printing and bringing them with you to your appointment.
Forms in English
Formularios en Español
Sliding Fee Scale Available
NKN Student Health & Wellness Center/Nehalem Bay Health Center provides care, on a sliding scale, regardless of the ability to pay. For more information on how to apply, please ask staff at the health center. You can download the sliding fee guidelines and application by following the links below.
