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 Emergency Consent Form for urgent same-day appointments at 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.
Oregon ONE Account Setup
View English and Spanish instructions below on how to set up an Oregon Eligibility (ONE) account online. Enroll online here.
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
Quick Links
Returning Patient Info
If you're a new patient, welcome to Woodburn Pediatric Clinic! Find new patient information and forms below.
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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