Registration Forms
- Patient Registration & Consent Form – English
- Formulario de Registro y Consentimento del Paciente – en Español
- Форма регистрации и согласия пациента – русский (Russian)
Sliding Fee Scale
- Sliding Fee Scale Attestation – English
- Sliding Fee Scale Application – English
- Declaración Jurada de Ingresos – en Español
- Programa de Escala de Descuento – en Español
Keep in Touch
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My OLE Health allows patients (18 years and older) to have better communication with their health center by allowing access from anywhere with an internet connection.
Patient Portal
- Log in to My OLE Health Patient Portal here
- Detailed instructions for activating your Patient Portal account
- Instructions for Connecting your OMRON Blood Pressure monitor to your Patient portal English – Spanish
Tele-Video / Virtual Visit Checklist: English – Spanish
Secure Video Conferencing Instructions – Zoom Only
- Instructions for Android Phones: English – Spanish
- Instructions for Apple/IOS Phones: English – Spanish
Patient Forms
- Registration Form – Registro del paciente
- Affidavit of Income – Declaración Jurada de Ingresos
- Release/Request of Information – Divulgacion/Solicitud de information
- CHDP Pre-Enrollment Form
- Access to Health Programs Form – Formulario de acceso a programas de salud
- Pregnancy Test Flyer English – Spanish
- Personal Representative Designation Form/Formulario para Designar a un Representante Personal
Consent Forms for Caregivers
Dental Forms
- Dental Medical History English – Spanish
- Dental Policies & Procedures English – Spanish
- Dental DMFS Acknowledgment English – Spanish
- Dental Consent Treatment English – Spanish
Behavioral Health Forms
- Behavioral Health Intake Form English – Spanish
- Consent for Treatment – Long Term English – Spanish
- Consent for Treatment – Short Term English – Spanish
- Patient Portal Questionnaire Instructions English – Spanish
- Napa County Behavioral Resources English – Spanish
- Solano County Behavioral Resources English – Spanish
Staying Healthy Assessment Forms