Patient Forms

Patient Registration Form
File Size: 160 kb
File Type: pdf
Download File
Health Questionaire
File Size: 166 kb
File Type: pdf
Download File
Payment Policies and Patient Responsabilities
File Size: 548 kb
File Type: pdf
Download File
Release of Information
File Size: 64 kb
File Type: pdf
Download File
Notice of Privacy Practices
File Size: 555 kb
File Type: pdf
Download File
Privacy Practices Acknowledgement Form
File Size: 141 kb
File Type: pdf
Download File
Medicare Annual Wellness Questionnaire
File Size: 409 kb
File Type: pdf
Download File

Screening and Immunization Resources

Immunization Recommendations: Birth - 6 years old

Immunization Recommendations: 7 - 18 years old 

Men: Stay Healthy at Any Age - Health Screening Guidelines

Women: Stay Healthy at Any Age - Health Screening Guidelines 

Choose My Plate - Tips for a Healthy and Balanced Diet

Insurances We Accept

Always verify coverage with your
​insurance company directly    
  • AARP Medicare Complete
  • Aetna
  • Beech Street
  • BlueCross BlueShield
  • Care Oregon
  • Caremark
  • Cigna
  • Conventry
  • First Choice
  • First Health
  • GEHA
  • GreatWest
  • Hartford
  • Health Net ​
  • Healthshare  
  • ​Humana
  • ​Kaiser Added Choice​​
  • Lifewise
  • ​Mail Handlers
  • Medicaid
  • Medicare
  • MedAdvantage - BCBS
  • Motor Vehicle Ins
  • UHC MedicareComplete
  • MHN Caremark
  • MODA/ODS
  • Pacific Source
  • Progressive
  • Providence(OON)​
  • Regence
  • Worker's Compensation
  • Secure Horizons
  • Tricare / Triwest
  • UMR
  • UnitedHealthcare

Resources for the Uninsured

Uninsured / Self - Pay Patient Rates 

$120 for New Patient Appointments

$90 for Established Patient Appointments

The above fees will cover evaluation of a single illness or injury.  If other services or a more comprehensive evaluation and treatment are required, there may be additional charges.   
Discounted Lab Work 
We offer lab work to uninsured patients at a discounted rate. If you are interested in more information, please contact the clinic at 
(503) 665-1010.  
Options for Making Payments 
You may pay by cash, check, or credit/debit card. 
 Payments can be made in person, by phone, by mail or online here.