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.
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.
- Notice of Privacy Practices
- Patient Rights and Responsibilities
- Annual Patient History 0-17 (English) (Español)
- Patient History – Pediatric 0-4 years (English) (Español)
- Patient History – Pediatric 5-11 years (English) (Español)
- Patient History – Pediatric 12-18 years (English) (Español)
- Annual Patient History 18+ (English) (Español)
- FHA Patient Information (English) (Español)
- Record Request Authorization (English) (Español)
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.
|1 Month||1 month|
|2 Months||2 months||2 months|
|4 Months||4 months||4 months|
|6 Months||6 months||6 months|
|9 Months||9 months||9 months|
|12 Months||12 months||12 months|
|15 Months||15 months||15 months|
|18 Months||18 months||18 months|
|2 Years||24 months + M-CHAT||24 months + M-CHAT|
|2 1/2 Years||30 months||30 months|
|3 Years||3 years||3 years|
|4 Years||4 years||4 years|
|5 Years||5 years||5 years|
|6-10 Years||6-10 years|
|11-12 Years||11-12 years|
|13-17 Years||13-17 years|
|18-21 Years||18-21 years|