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Haywood County, NC
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Forms

Patient Forms for Public Health


DENTAL

Consent for Services

Permission to Delegate Dental Treatment and Disclosure of Health Information

Policies and Procedures

Patient Medical History

NEEDED FOR ALL CLINICAL SERVICES

Demographics Form (English/Spanish)

BREAST AND CERVICAL CANCER

Demographics Form (English/Spanish)

List of Acceptable Documents for Proof of Identification

List of Acceptable Documents for Proof of Income

FAMILY PLANNING

List of Acceptable Documents for Proof of Identification

List of Acceptable Documents for Proof of Income

Demographics Form (English/Spanish)

Female Reproductive Health History

IMMUNIZATION

Demographics Form (English/Spanish)

List of Acceptable Documents for Proof of Income

WIC

WIC PreScreening Tool

List of Acceptable Documents for Proof of Identification 

List of Acceptable Documents for Proof of Income

List of Acceptable Documents for Proof of Residence 

PROVIDER FORMS FOR PUBLIC HEALTH

Communicable Disease

Communicable Disease Reporting Form and Instructions for Providers

Animal Bite Report Form for Providers


  1. Breast & Cervical Cancer Control Program (BCCCP)
  2. Child Health
    1. CC4C
    2. School Health
  3. Dental
  4. Disease Testing & Tracking
  5. Family Planning Services
  6. Forms
  7. Health Education & Healthy Haywood
  8. Immunization for Children, Adults & Travlers
  9. Physical Exams & Testing
  10. Pregnancy, Prenatal Care & Education
  11. Preparedness
  12. Resources in Haywood County
  13. WIC Nutrition Program
  14. COVID-19 Economic Resources
Report Abuse
Online Child Support Services
Apply for Benefits Online
Health Registration Forms
Environmental Health Forms
  1. Home page

Contact Us

  1. Haywood County NC
    Health & Human Services Agency

    157 Paragon Parkway
    Clyde, NC 28721
    Hours of Operation: M-F 8-5

Municipalities

  1. Town of Waynesville
  2. Town of Maggie Valley
  3. Town of Clyde
  4. Town of Canton
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Quick Links

  1. North Carolina 2-1-1: Search for a Variety of Services by County and Services Type
  2. Suicide Help Line
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