Patient Forms

Download and complete these convenient PDF forms prior to your appointment. You’ll need the Adobe Reader to view and print the documents.

WFPG Welcome Brochure

+  Provider bios, contact information and clinic maps

Patient Registration Form

+  New Patients: bring with you on your first visit
+  Current Patients: change or update your current info

Financial Policy

+  Review and sign before first visit

HIPAA Notice of Privacy Practices

+  Review and sign before first visit

Terms & Conditions of Service

+  Review and sign before first visit

WFPG Patient Health Records Release

+  Authorization to use and disclose protected health info

Motor Vehicle Accident Insurance Information Report

+ Assists billing department to accurately direct insurance claims

Oregon
Healthy Kids

Depending on family income, children may be eligible for free or low-cost health coverage for doctor visits, dental care, vision, medicines and more through the Healthy Kids program. Visit our links page for more information.