Below are my two model classes
class Patient < ActiveRecord::Base
belongs_to :user, :dependent => :destroy
has_many :enrollments, :dependent =>
In Rails 3 (not sure about previous versions) you don't even need to use accepts_nested_attributes_for to accomplish this. You can simply remove all the view code you listed and replace it with the following:
<%= patient_form.select(:client_ids, @clients.collect {|c| [ c.name, c.id ] }, {}, {:multiple => true})%>
Rails will do its magic (because of you named the select "client_ids") and it will just work.