Patient Registration and Consent for Services

Please Fill out the Consent Form Below:

Please read the HIPAA Notices of Privacy and Practices before filling out the form.

Please note: FNCH complies with the New Mexico Statutes Annotated (NMSA) regarding Minors’ Consent for Health Care Services in New Mexico. Under state law, these statutes provide exceptions under which a minor, 14 years and older, can consent for services without requiring parental/legal guardianship consent. A summary of these statutes is included on this webpage. Additional information may be obtained by accessing the following links: