full screen background image
INFORMATION
PATIENT RESOURCES
OUR TEAM
MEDIA
DONATIONS
   PATIENT FORMS
Please feel free to read and or print these forms


New Patient Forms Packet (Jul2019)
 
Established Patient Forms Packet-07/2017
 
Patient Acknowledgement & Consent for Health Information Disclosure, Evaluation, Treatment, and Billing (Jul2019)
 
Patient Approved List of Contacts (Jul2019)
 
Patient Authorization for Electronic Health Records (Umpua One Chart)(Updated 09/2013)
 
Patient Financial Assistance Application (Jul2019)
 
Patient Financial Assistance Policy (Jul2019)
 
Dietary Supplements List Form
 
Patient History Questionnaire-07/2017
 
Patient Self-Assessment Form
 
Symptom Assessment Form
 
Patient Notice of Privacy Practices-05/2017
 
Patient Satisfaction Survey
 
FredMeyer Community Rewards
 
2015 FOH 10k & 5k Results
 
2016 FOH 5k Results
 
2017 FOH 5k Results
 
2018 FOH 5k Results
 
DEEP | Diabetes Class Flyer (UHA)
 
SOLE Survive-N-Thrive (Walking Groups)
 
Tobacco Cessation Flyer 2019_04
 
FRESHSTART® Summer Tobacco Cessation 4-Week Course
 
Spiritual Care
 
Cancer Support Group 2019-20
 
Living Well Programs Jul 2019-Jun 2020
 
Living Well CTSSMP 2020
 
 Admin Login
© Copyright 2019 Community Cancer Center. All Rights Reserved.