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Partnership Health Center
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    • Dental
    • Behavioral Health >
      • Self-Care Resources
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      • Medicare Wellness Visit
      • Montana Cancer Screening Program
      • Medical Legal Partnership
      • Certified Application Counselors
      • Sports Physicals
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FORMS

Missoula Creamery Clinic Building

Forms

 Our most frequently used forms can be found on this page. Please contact us if you have questions.

Registration

​Missoula Medical & BH Registration Form
Missoula Dental Registration Form

Seeley Medical & BH Registration Form
Seeley Dental Registration Form

Montana Cancer Screening Program Registration

Prefer to fill your registration form out by hand?
​
Click here for a printable version (good at all sites)

Need to give us a quick update?
Click here to send us a copy of your photo ID
Click here to send us your insurance card(s)

Releases of Information (ROI)

Medical ROI
​Dental ROI

Prefer to fill your release form out by hand? 
Click here for a printable version of the medical ROI
Click here for a printable version of the dental ROI
​

Consents & Notices

Patient Rights and Responsibilities​
Notice of Privacy Practices

​​Parental Consent Form
​Verbal Communication Authorization
​Dental Services Agreement
​Certified Application Counselor (CAC) Consent

Financial Assistance

Missoula Sliding Fee Scale Application
Seeley Sliding Fee Scale Application
  • Click here to send us a copy of your proof of income

Sliding Fee Scale discounts apply at all of our sites but
are processed at the clinic you visit most regularly.

Click here to learn more about the Sliding Fee Scale.


Payment Agreement Form (PDF)
Payment Agreement Form (fillable)

Pharmacy Payment Agreement Form (PDF)
Pharmacy Payment Agreement Form (fillable)
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Logo of Partnership Health Center-- Missoula's Community Health Center
401 Railroad St. W 
Missoula, MT 59802

​Main Line: (406) 258-4789
​
Dental: (406) 258-4185
Behavioral Health: (406) 258-4789
Pharmacy: (406) 258-4139
Billing: (406) 258-4195
Fax: (406) 258-4732

View hours at all our locations here.

Contact PHC


Find Us

We are conveniently located in downtown Missoula at 401 Railroad St. W. We are easily accessed from I-90 via the Orange Street Exit. PHC is also just blocks away from the Mountain Line Transfer Station, also located downtown.
This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.
 NOTICE OF NONDISCRIMINATION: 
Partnership Health Center does not discriminate against any person on the basis of race, color, national origin, disability, age, or sex (gender) in admission, or access to, or treatment, or employment in, its programs, services, or activities.  
Read the Full Notice:  Partnership Health Center Notice of Nondiscrimination
Español  |  Tiếng Việt  |  繁體中文  |  한국어  |  Русский  |  العربية  |  Deutsch  |  Français  |  Tagalog  | ภาษาไทย  |  Norsk  |  Українська  |  Deitsch  |  Italiano  |  日本語 

LIMITED ENGLISH PROFICIENCY ASSISTANCE: 
Partnership Health Center
provides language assistance services, including translated documents and oral interpretation, to individuals with limited English proficiency. We provide assistance in the following languages:
Español  |  Tiếng Việt  |  繁體中文  |  한국어  |  Русский  |  العربية  |  Deutsch  |  Français  |  Tagalog  | ภาษาไทย  |  Norsk  |  Українська  |  Deitsch  |  Italiano  |  日本語 

Partnership Health Center respectfully acknowledges that we occupy the traditional homelands of the Séliš, Qĺispé, and Ktunaxa-Ksanka nations. We also recognize that these lands are a site of trade, medicine gathering, healing, and travel for other Native tribes in the area and is still home for many Indigenous people. We extend our gratitude for those who have stewarded this land since time immemorial.
 
We acknowledge that the health care system has played a role in the oppression of Indigenous peoples. We commit to ongoing learning about the impact of colonization on the health and wellbeing of Indigenous peoples, and we commit to meaningful action that reverses health inequities.

​
  • Services
    • Medical
    • Dental
    • Behavioral Health >
      • Self-Care Resources
    • Pharmacy
    • Telehealth
    • Additional Services >
      • Medicare Wellness Visit
      • Montana Cancer Screening Program
      • Medical Legal Partnership
      • Certified Application Counselors
      • Sports Physicals
  • Patients
    • Appointments >
      • Online Scheduling
    • Forms
    • Financial Assistance >
      • Sliding Fee Scale
      • Good Faith Estimate
    • Patient Web Portal
    • Pay My Bill
  • About
    • Welcome
    • History
    • Who We Are
    • Our Providers
    • Locations & Hours
    • Education and Training
    • Donate
  • News & Events
    • Public Meetings
    • Events and Announcements
    • PHC in the News
    • COVID-19 Updates
  • Careers
  • Contact Us
    • Provide Feedback