Forms

Find What You Need. Feel Prepared.

  • For Your Review

    Welcome to our information center, where you'll find important documents that empower both parents and providers in delivering exceptional care. These documents cover topics such as privacy practices, access to healthcare information, feedback opportunities, and your rights and responsibilities as a patient. Reviewing and understanding these resources not only ensures compliance but also strengthens our partnership in caring for your child.

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  • New Patient Forms

    Our New Patient Forms are essential for establishing your child's healthcare at Clackamas & Oregon Pediatrics. These documents help us understand your child's medical history, your preferences, and how to best engage with your family regarding your child's health. Completing these forms empowers us to provide personalized and effective care, creating a strong foundation for your child's well-being.

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  • Well Child Care Visit

    Explore our well child care visit forms, thoughtfully designed to enhance your child's health and development. These forms are instrumental in providing tailored care and safeguarding your child's well-being

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  • Behavioral Health

    In our commitment to providing holistic care, we offer a range of behavioral health forms that facilitate a deeper understanding of your child's emotional and mental well-being. These forms encompass assessments, questionnaires, and consent documents that support our behavioral health specialists in tailoring their care to your child's unique needs. Completing these forms is a vital step in initiating a collaborative journey towards your child's emotional wellness.

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  • Billing & Financial

    At Oregon Pediatrics, we aim to provide you with a seamless healthcare experience, and that includes the financial aspects. Our billing and financial forms are designed to simplify the process for you. These forms cover important areas such as insurance verification, payment plans, and other essential financial documentation. By completing these forms, you're taking an essential step towards ensuring a smooth and stress-free financial experience with us.

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  • Vaccination Forms

    Our Vaccination Forms are designed to ensure your child receives essential vaccines, protecting them from preventable diseases. These forms help us keep accurate records of your child's immunization history, enabling us to provide the best care possible.

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For Your Review

  • We are committed to providing quality healthcare and respecting your patient rights. We take all feedback, comments, and/or concerns very seriously and will not retaliate for filing a complaint.

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  • The HIPAA Notice of Privacy Practices outlines the protection of your child's health information, ensuring confidentiality and compliance with privacy regulations.

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  • As a patient, you have a right to receive quality care. This form shares more education on your rights and responsibilities.

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Patient Forms

  • Our patient registration forms streamline the onboarding process, enabling us to gather essential information about your child.

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    General Registration Form

    Lactation Registration Form

  • This form gives us permission to securely obtain and share your child's health information as needed

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  • The Authorization of Delegate form allows you to designate a trusted individual who can act on your behalf when it comes to your child's healthcare, ensuring seamless communication and support. If you have any questions, please call 503-659-1694 ext. 400.

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  • Proxy access can be revoked at any time.

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Wellness Care

  • The Sports Physical forms are essential for ensuring your child's readiness and safety in sports activities, helping our team assess their physical health and fitness for participation.

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  • The Wellness Schedule form helps you stay on top of your child's health by providing a structured plan for their wellness visits and immunizations, ensuring they receive the necessary care at the right time.

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Behavioral Health Forms

  • The ADD-ADHD Vanderbilt Form is a valuable tool that assists us in understanding your child's behaviors, ultimately helping us provide the most appropriate care and support.

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    For Parents

    For Teachers

  • This form form empowers you to grant Oregon Pediatrics permission to securely obtain and share your child's health information as needed.

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Billing & Financial

  • Thank you for choosing Clackamas & Oregon Pediatrics for your pediatric health care needs. Our goal is to provide the highest quality medical services to our patients at a reasonable cost. If you have any questions or concerns about our financial policy, please contact an account representative at: (503) 427-2118 Monday through Friday 9:00 AM - 5:00 PM.

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  • We do not require 24-hour notice for appointment cancellations as we know life can sometimes be unpredictable. Since disruptions to the schedule impact other patients and clinic staff, we are providing you with our Appointment Policies.

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Vaccination Forms

  • The Flu Vaccination Form helps us track your child's immunization history, ensuring they receive timely flu vaccinations for added protection during flu season.

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Have Questions?

If you have any questions, need assistance, or require further information about our forms or any other aspect of our care, please don't hesitate to reach out. Our dedicated team is here to support you and your family on your healthcare journey.