Call us for more details or drop off forms directly to the office.
New patient forms
Complete one from medical history, one demographics and one medical record disclosure.
Medical History
Newborn to 2 years of age
3 to 14 years of age
15 to 107 years of age
Demographic sheet
This form allows us to gather your patient information in advance to speed up the check in process at your first visit.
Medical records disclosure
This form allows us to request medical records from your previous doctors.  Obtaining a comprehensive medical history is crucial to providing you with the best health care. Please complete one form for each of your previous doctors.
Controlled substance policy
Please complete this form if you are currently taking any type of controlled substance(s).  Examples of controlled substances include Morphine, Oxycodone, Hydrocodone, Dilaudid, Ativan, Xanax, and Valium.  Please include prescribed and others.
Kids Forms
NICHQ Vanderbilt Assessment
This is an assessment for ADD/ADHD.   There is a “Parent” form, and this should be accomplished by 2 different adults from where the child lives. There is also a “Teacher” form which should be accomplished by 2 different teachers at school. You will need an appointment to review these.  Please drop them at the office in advance of the appointment for scoring.
Asthma action plan
This form is used to provide guidance for home management of asthma as it worsens or improves. This helps the parent adjust the medicine and decrease doctor visits.
Acetaminophen/Ibuprofen Child Dosing
This provides an overview of dosing guidelines.  It is always appropriate to contact the clinic for more detailed guidance.
Sports Physical Forms
These forms have a history portion which should be completed prior to the visit.
Pop Warner
General sports physical
Additional Resources
Healthy Children
go there
Poison Control
go there
Additional forms and resources
Controlled substance policy
Please complete this form if you are taking any type of controlled substance. Examples of a controlled substance oxycodone, Xanax, hydrocodone, Ativan.  
Vasectomy Forms
Vasectomy 101
This is a general overview of the preoperative visit, procedure day and what to expect in recovery.
Life planning
These forms document your medical care preferences.
POLST form
This form is valid statewide and is intended as a rapid guide for emergency responders.
Advance Directive
This form allows more detailed instructions for your healthcare, and this can be created using a worksheet available on the State of Oregon Website. This is sometimes done with a lawyer’s assistance.