Patient Forms

In order to provide your child with the best health care possible, we ask that you complete our new patient forms prior to your first visit.

Welcome Letter

We are delighted to have your child as a patient and appreciate the opportunity to be their primary medical care provider. Please review our welcome letter attached. Below you will find the new patient forms necessary for your child’s first appointment.

New Patient Forms

Please complete the New Patient Forms in order to begin the process of joining Woodburn Pediatric Clinic.

Emergency Consent

Please complete the New Patient Forms in order to begin the process of joining Woodburn Pediatric Clinic.

HIPAA Form

HIPAA stands for Health Insurance Portability and Accountability Act, which aims at protecting the sharing and accessing of medical and personal information. This form allows Woodburn Pediatric Clinic to use and disclose health information for various reasons detailed in the document attached.

Financial Policy Form

It is our goal to make sure you receive the maximum financial benefit from your insurance provider and to make sure that your account is handled in the most efficient manner possible. In order to accomplish this goal, it is important that we have your understanding and cooperation to our financial policies attached.

Health Information Authorization

This form authorizes Woodburn Pediatric Clinic to use or disclose protected health information such as immunization record, hospital record, and more outlined in the document attached to the recipient of your choosing.

Notice of Privacy Practices

This form describes hot medical information about you may be used and disclosed and how you can get access to this information.

Get in Touch

Address
2050 Progress Way
Woodburn, Oregon, 97071
Phone
503-981-5348
Business Hours
Mon - Thur: 8:00am - 7:00pm
Friday: 8:00am - 5:00pm
Saturday: 9:00am - 12:00pm (Urgent Care Only)
Sunday: Closed

Quick Links

New Patient Info

New patients are always welcome at Woodburn Pediatric Clinic!

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    Same-day appointments are available if you call first thing in the morning.

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    Arrive between 15 to 30 minutes early for your appointment to ensure timely care.

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    Discuss expectations about the visit with your child to help them process any fears or anxieties.

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