Today's Hours: Monday 8:00 AM - 4:00 PM

For life-threatening emergencies such as active chest pain, please call 911.

For life-threatening emergencies such as active chest pain, please call 911.

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FORMS

Contact Information

General Inbox

Patient Registration Email *

7520 Totem Beach Rd
Tulalip, WA 98271

* By utilizing this email address to send your registration documents and PII (Personal Identifiable Information) to the Tulalip Health Clinic Registration Team, you are releasing the information to the Tulalip Health Clinic Registration Staff in order to register you as a patient with our clinic. Please put in the email subject and in the body of the email “FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE” Please also note that you will not receive a reply from this email address, as it is for documents only. For further assistance, please call 360-716-4511.

Forms and Documents

COVID Vaccines

Prevaccination Checklist for COVID-19 Vaccines

Employee Registration Form

Employee Registration Form

About Us

pdf Direct Care Patient Letter

pdf Health Clinic Patient Information

pdf Release of Information

Acknowledgment Of Paternity

pdf Acknowledgment of Paternity

Authorization For Treatment

pdf Authorization for Treatment

Behavioral Health

pdf Release of Information

Behavioral Health Adult Mental Wellness

pdf Mental Wellness Request for Services

pdf Office Policies & Consent to Treatment (AMW)

pdf Employee Registration Form

Behavioral Health Chemical Dependency

pdf Case Specialist and Outreach Transportation Brochure

Behavioral Health CYF Mental Wellness

pdf Assignment of Benefits

pdf Authorization to Provide Outreach Transportation

pdf Authorization to Release Obtain Exchange PHI

pdf Child Adolescent Intake

pdf Office Policies & Consent to Treatment (CYF)

pdf Request for Services (Youth Referral)

pdf Frequently Asked Questions (FAQ)

pdf Notice of Privacy Practices

pdf Telebehavioral Health Information

pdf Telebehavioral Health Informed Consent

Behavioral Health Healing Lodge

pdf Healing Lodge Brochure

Community Health Community Nursing

pdf Elder Wellness Services Flyer

pdf Maternal Infant Health Program Flyer

pdf Support Circle Flyer

Community Health Prevention Education

pdf Quit Smoking Brochure

Community Health Transportation

pdf Tulalip Health Systems Transportation Flyer

Consent Form For Minors

pdf Consent Form for Minors

Contract Health Services

pdf Condensed PAP Policy

pdf Patient Assistance Program for Tulalip Elders

pdf Patient Assistance Program for Tulalip Members

pdf Assistance Program for Other Natives

Dental Care Orthodontics

pdf Orthodontic Program Brochure

pdf Dental Clinic Retainer Wear Brochure

pdf Dental Rapid Palatal Expander Brochure

Forms

pdf Prevaccination Checklist for COVID-19 Vaccines

pdf Employee Registration Form

Medical Care Diabetes Program

pdf Mission Vision Collaborative Relationships

pdf Medicine Wheel Garden

pdf Farm Tour & U-Pick

Medical Care Podiatry

pdf Foot Care Tips

Npp Acknowledgment

pdf NPP Acknowledgment

Patient Registration Checklist

pdf Patient Registration Checklist

Patient Registration Form

pdf Patient Registration Form (Must be downloaded)

Tt Chs Verification Of Residency

pdf TT CHS Verification of Residency