Patient Forms

Before your appointment with us, quickly and conveniently access patient forms from our practice.

We will do our best to process new patient requests within 5 business days. We receive an extremely large number of new patient requests each day, but new patient requests will be processed as quickly as possible. If you are not contacted within 2 calendar weeks, please contact our office by phone, at (541) 567-6434 ext 207.

Please be aware that previous medical records will be required to assure that we can provide for your medical needs. Please request your previous records by filling out an ROI, Release of Information form and giving it to your previous provider.

To view the forms listed below, you will need to download Adobe Reader. Please bring your completed forms with you to our office at the time of your visit.

Pediatric Development Screening Forms

When preparing for your child’s next well child visit, please select and print the age-appropriate form from the list below, fill it out completely, and bring the form with you to your child’s appointment.

Child’s AgeEnglishSpanish
2 Months2 month2 month
4 Months4 month4 month
6 Months6 month6 month
9 Months9 months9 months
12 Months12 month12 month
15 Months16 month16 month
18 Months18 month + M-CHAT18 month + M-CHAT
2 Years24 month + M-CHAT24 month + M-CHAT
2 1/2 Years30 month30 month
3 Years36 month36 month
4 Years48 month48 month
5 Years60 month60 month