If you are a new patient or are scheduled for an annual physical, please complete the appropriate Medical History Form prior to arriving for your appointment:

Adult Medical History Form ~ (pdf) for patients older than 18 years of age

Pediatric Medical History Form ~ (pdf) for patients from 0 – 18 years of age

Privacy Statement ~ (pdf) Doctors’ Clinic Privacy Statement

Nondiscrimination and Accessibility Notice~(pdf)

Authorization to use/disclose Protected Health Information  ~ (pdf) Authorization to Use/Disclose Protected Medical Information can be used to give us permission to transfer your personal medical  records to another provider.  Please complete the form and mail the original signed form to:

WVP-The Doctors’ Clinic
5050 Skyline Village Loop S.
Salem, Oregon 97306
Attn:  Medical Records Custodian.

Sports Physical Form ~ (pdf) For Sports Physicals

Advanced Directive Form ~ (pdf) For Advanced Directives

If you wish to obtain more information and appropriate legal forms which allow you to express your wishes for care if you become unable to decide in the future, please call Oregon Health Decisions toll free directly at 800-422-4805

POLST Form

Physician Orders for Life Sustaining Treatment : This form is intended for patients with serious health conditions. It is a bright pink medical order form that needs to be discussed with and signed by your physician. The form can be obtained in our office.