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
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:
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
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.