For your convenience, you can print and complete the necessary new patient forms prior to your visit. Please give them to the receptionist at the time of your appointment or fax them to 503 557-8651. Just click on the desired form to download it to your computer. Adobe Acrobat Reader is needed for viewing:
Registration Forms
- Patient Registration Form - English
- Patient Registration Form - Spanish
- HIPPA Notice of Privacy & Receipt - English
- HIPPA Notice of Privacy & Receipt - Spanish
- HIPPA Consent Form - English
- Financial Policy
- Financial Policy-Spanish
General Forms
- Authorization to Treat in Absence of Parent or Guardian - English
- Authorization to Treat in Absence of Parent or Guardian - Spanish
- PHI Release Form - English
- PHI Release Form - Spanish
- Update Emergency Contact and/or Parent Divorce
Developmental Screening Forms
9 Month Well Child Check
- Developmental Questionnaire - Please arrive early to complete this form
- ASQ Questionnaire
12 Month Well Child Check
18 Month Well Child Check
- Developmental Questionnaire - Please arrive early to complete this form
- Autism Screening Questionnaire – MCHAT – English
- Autism Screening Questionnaire – MCHAT – Spanish
- ASQ questionnaire
24 Month Well Child Check
- Developmental Questionnaire - Please arrive early to complete this form
- Autism Screening Questionnaire – MCHAT – English
- Autism Screening Questionnaire – MCHAT – Spanish
- ASQ questionnaire
30 Month Well Child Check
3 Year Well Child Check
- Developmental Questionnaire - Please arrive early to complete this form
4 Year Well Child Check
- Developmental Questionnaire - Please arrive early to complete this form
5 Year Well Child Check
- Developmental Questionnaire - Please arrive early to complete this form
ADD / ADHD Forms
- ADD-ADHD Teacher Initial Assessment - Vanderbilt
- ADD-ADHD Parent Initial Assesssment - Vanderbilt
- Vanderbilt Parent Follow Up Visit
- Vanderbilt Teacher Follow Up Visit