Background: Refugees are a culturally diverse group with special healthcare needs and challenges. In addition the stress of adjusting to a new environment makes it difficult for them to learn how to use the U.S. healthcare services. The Nationalities Service Center is a resettlement agency, which provides refugees with a health orientation to teach them about the U.S. health care system. Objective: To evaluate the effectiveness of the health orientation in increasing refugees' knowledge and understanding of the U.S. healthcare system. Methods: This study was conducted using a mixed methods approach. Three focus groups and 5 interviews were conducted and an 8-item questionnaire was administered to participants before and after the health orientation. A non-random convenience sample of 33 adults from Nepal, Burma, and Iraq were recruited into the study. Group meetings were audio taped, and transcribed. A two-tailed t-test was used to establish statistical significance between the pre and post-tests. Results: There were three themes that emerged from the focus groups. Many participants did not read health material, because they couldn't read English. Majority requested more information on medical health insurance. Finally many participants mentioned that the health care system in their country was different from that of the U.S. Analysis of the pre and post questionnaires revealed that there was a 15% increase in knowledge with a significance of (p