Wellness Exam forms:   

• Children 0-4 yr Form
  

• Children 5-11 yr Form
  

• Adolescent 12-17 Form
  

• Well or new patient adult woman
  

• Well or new patient adult male
  

Registration forms:

• Contact information and HIPAA release Form
  

• HIPAA notice - short version
  

• HIPAA Privacy Handbook
  

• Financial Policy
  

• Minor consent for treatment
  

• Release of Information to PFP
  

• Release of Information from PFP
  

• Disclosure of Information to Family/ Friends
  

Telephone:

(503) 233-6940

(503) 236-2676 (fax)

Support the fight against AIDS

Support the fight against Breast Cancer

If you are having trouble opening any of these forms please click here to download ABODE READER

Recommended Childhood Health

maintenance schedule

• Patient satisfaction survey form
  

CDC resource for animal bites/possible Rabies exposure.  Print and complete this form if you have had an animal bite and bring with you to your appt.

Website Designed at Homestead™ Make a Website for Your Business