Please take a look at the forms below:


​​REGISTRATION FORM

This provides our office with all the necessary information to register you once we accepted you into our practice.






VOLUNTARY INFORMATION DISCLOSURE

This form explains your voluntary information collected by our electronic health record.



HIPAA

This form consents us for using and disclosing your health information for purpose of management of your health care.



AUTHORIZATION TO RELEASE MEDICAL RECORDS

This form authorizes your prior doctors to release medical records to our office





REVIEW OF SYSTEM

Please complete prior to coming into each appointment.  This informs us of how you are feeling for the visit and assists us in providing a thorough evaluation of your health for the day of the visit.



Call us: 541-926-4828


Mid-Willamette Family Medicine