Patient Forms…

Download and complete these convenient PDF forms prior to your appointment, then hand it to a receptionist when you arrive at the clinic. 
You’ll need the Adobe Reader to view and print the docments below (don't worry, it's free):

WFPG Welcome Brochure
+ downloadable provider bios, maps, and contact information

Patient Registration Form
+ NEW PATIENTS — fill this out and bring with you on your first visit
+ CURRENT PATIENTS — use this form to change or update your current information

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 information

Motor Vehicle Accident Insurance Information Report
+ assists billing department to accurately direct insurance claims

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© Copyright 2008 All Rights Reserved, Willamette Falls Pediatric Group

Clinic Forms

Now Online!

Save time on your next visit—
Download and complete needed forms in advance, then give it to a receptionist when you arrive for your appoinment.  Click on the ”forms” link on the left side of the page.

Now Open:

WFPG Canby!

This summer we joined the new Willamette Falls Health Center and the Women’s Health Center in the brand new Canby Plaza, on the corner of Sequoia Parkway and Hazel Dell Way.