Patient Forms
This page contains numerous patient forms that you may find helpful. Filling these forms out ahead of time can help streamline your visit.
Download Adobe Reader All forms are in Adobe PDF format. You will need the free Adobe PDF Reader to view or print them.
First Visit and Yearly Exam
- Patient Information Basic information we need on your first visit.
- Problem List To help you organize the things to discuss with your doctor.
- What To Expect What to expect at your first visit and your yearly examination.
Miscellaneous
- Patient Rights / Privacy Practices How medical information about you may be used and disclosed.
- Glucose Testing Directions Directions for the various Glucose tests.
- Flu Like Symptoms What to do if you are experiencing flu like symptoms.
- Cholesterol Panel Guidance on how to interpret your cholesterol test.
- Patient Satisfaction Survey We value your opinion and comments regarding our practice.
Consent Forms
- Privacy Addendum To allow another person access to your information.
- Privacy Addendum For Minors For patients under age 18 to authorize access to another person.
- IUD Consent Form Consent for insertion of Paraguard or Mirena IUD.
For Our Pregnant Patients
- Congratulations On Your Pregnancy! An overview of what to expect during your obstetrical care.
- If You Are Pregnant and Have a Cold What to take and when to call us.
- Mercury Exposure Fish and seafood recommendations for pregnant or nursing mothers.
- Pediatrician Information Recommended pediatricians in the Portland area.
- Insurance Company Questions Prenatal and delivery questions to ask your insurance company.
Financial Information
- Office and Financial Policies Basic billing information, referrals and discounts.
- Financial Forgiveness Policy Eligibility information and request form for financial forgiveness.
- Free or Sliding Scale Clinics Options for free or sliding scale clinics in the Portland area.
Records Transfer
- Medical Information Release Authorization to use/disclose protected health information.
- How To Transfer Records Instructions for transferring records to or from Gateway Women’s Clinic.