Patient Forms

At Lourdes Health Network, we want to ensure the easiest admitting process for you. To streamline your admission, you can simply download and print the forms below. (All forms are in PDF format)

Patient Registration
Download and fill out our patient registration form prior to your first visit to Lourdes Medical Center or any of our patient clinics.
Lourdes Patient Registration Form

Patient Billing
Lourdes Health Network is committed to providing you with the best medical care possible. This includes the handling of your bill. We want to help you understand your bill and answer any questions you may have. Please visit the Lourdes Patient Billing and Financial Aid page for more detailed information.

Financial Assistance
We want to make sure you receive the health care you need regardless of your ability to pay. This program is intended for patients who cannot afford or do not qualify for health insurance, and/or have very limited financial resources, or who have incurred sizable medical bills that are beyond their ability to pay. Any patient can apply for financial assistance with medical bills. Eligibility will be determined based on your household income.
Lourdes Financial Assistance Application

Understanding Your Hospital Bill
Lourdes Health Network is committed to providing you with the best medical care possible.
This includes the handling of your bill. We want to help you understand your bill and answer
any questions you may have.
Understanding Your Hospital Bill at Lourdes Health Network

Advance Directives
An Advance Directive is a document which allows you to give directions about your future medical care, including living wills and power of attorney. An Advance Directive will let your family, friends, and health care providers know your wishes regarding medical care if you are ever unable to express them.
Lourdes Advance Directives Information Packet - English

Hoja de Informacion Sobre las Directivas Avanzadas
En cumplimiento con las leyes federales y estatales, “Lourdes Health Network” provee la siguiente información a todos los pacientes. “Lourdes Health Network” esta dedicado al cuidado de las personas enfermas, de los que sufren y de los moribundos. El respecto a la vida, el apoyo a la dignidad individual y el bienestar del paciente son valores cristianos centrals a la misión del “Lourdes Health Network”.
Hoja de Informacion Sobre Las Directivas Avanzadas - En Espanol