Patient Forms

All forms are available at the front desk when you check in, and Spanish versions will be posted soon.

Pediatric Developmental Screening (ASQ) Forms:

Before you bring your child in for a well check, we ask that you download and complete the appropriate Developmental Screening form for your child based on age, below.
ASQ forms (English)

ASQ forms (Spanish)

Immunization Exemption Form:

By far, most parents in Oregon vaccinate their children. But parents who do not want their children to be vaccinated can claim a non-medical exemption for one or all school immunizations.
To claim this exemption through Columbia Gorge Family Medicine, you are required to watch an online education module and print a Vaccine Education Certificate at the link below. Note that the process for college students is a little different than the process for parents.
The link above will take you to Oregon’s Public Health Web site where you can watch the online education module and print your Vaccine Education Certificate.