All forms are available at the front desk when you check in, and Spanish versions will be posted soon.
Consent, Privacy Policies, and Release of Records
State and Federal laws (including, but not limited to, HIPAA) require that Columbia Gorge Family Medicine keep your medical information confidential and secure. The Notice of Privacy Practices below describes how medical information about you may be used and disclosed as part of your ongoing care, and how you can get access to this information.
Patients are asked to provide (and periodically update) a detailed medical history, health screen, and consent forms when under the care of Columbia Gorge Family Medicine. Patients may be asked to print and fill out the some of the forms below before coming in for your visit (Spanish versions coming soon).
- FD1 Financial Policy Agreement
- FD2 Patient Demographics Form
- FD3 Adult Health Screening Form
- FD4 Adult Health Questionnaire (Review of Systems)
- FD5 Adolescent/Teen Health Screening and Questionnaire (Review of Systems)
- FD6 Consent for Treatment
- FD7 Release of Records Authorization Form
Pediatric Developmental Screening (ASQ) Forms:
ASQ forms (Spanish)