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New patient or Wellness Exam intake forms:
Infants to 18 months
Children 18 months to 4 years:
* note: if your child is 1 year of age, please use the Children 1 year forms below
Children 1 year
Children 5 to 11 years
Adolescent 12 to 17 years
PHQ-9 Teen Depression screening
Teen CRAFFT substance abuse screening
Female Well or new patient 18 yrs +
Male Well or new patient 18 yrs +
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)
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If you are having trouble opening any of these forms please click here to download ABODE READER
Recommended Childhood Health
maintenance schedule
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.
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