This website is still under construction. Please stay tuned for further updates and features. Member Area Search for: MENU Contact New Patient Information, Forms & Policies < Go Back to Healthcare Page New Patient Our Siletz Community Health Clinic services CTSI tribal, other Federally Recognized tribal, and community members. CTSI and Federally Recognized tribal members may receive most SCHC services at no cost after insurance. Non-Federally Recognized tribal and Non-tribal members are responsible for the cost of services not covered by insurance. If you are interested in becoming a patient you must complete the Registration Packet (found below) with the following required documents: New Patient Registration Birth certificates (under age 18) Insurance card(s) Photo ID (age 18 and older) Social Security card or Number Tribal ID (if applicable) You may submit your registration with required documents: In person to our Patient Care Coordinators located at our Reception area By Fax: 541-444-9695 By Mail: PO Box 320; Siletz, OR 97380 By Email: medicalrecords@ctsi.nsn.us – note email is insecure at your discretion Medical appointments may be made by calling 800-648-0449 or 541-444-1030, Opt. 1. You need to check in at SCHC Reception area 15 minutes prior to appointment. New Patient Registration Packet (Adult) New Patient Registration Packet (2-18) New Patient Registration Packet (Birth - 2) Forms Registration Update Packet Consent for Treatment Authorization for the Use & Disclosure of PHI Receipt of SCHC NOPP Request Accounting Disclosures Request for Correction Amendment Request for Restriction(s) Request for Revocation for Restriction(s) Policies Service Eligibility Administration Policy (PDF) Financial & Payment Policy Notice of Privacy Practice Patient's Rights & Responsibilities Surveys Because We Care Client Satisfaction - Behavioral Health Patient Satisfaction - Dental Patient Satisfaction - Medical Patient Satisfaction - Optometry Patient Satisfaction - Pharmacy Hand Hygiene - Medical Hand Hygiene - Dental Hand Hygiene - Optometry Contact Siletz 201 SE Swan Ave. PO Box 549 Siletz, OR 97380 541-444-2532 Monday-Friday 8:00 AM – 4:30 PM Keep Up to Date Facebook Vimeo Search the Site Search for: Menu Government Heritage Services & Programs News & Events Employment Contact Copyright © 2021 Confederated Tribes of Siletz Indians Is there an issue on the website? Click here to contact the Webmaster. Clatsop | Chinook | Klickitat | Molala | Kalapuya | Tillamook | Alsea | Siuslaw/Lower Umpqua | Coos | Coquelle | Upper Umpqua | Tututni | Chetco | Tolowa | Takelma | Galice/Applegate | Shasta