Oregon Orthopedic Forms © Copyright 2011, 2012. Secure encrypted connection by SSL Please note that all forms must be completed using legal names. To complete and submit these forms* using Outlook, Eudora, or (Mac) Mail, simply select the form, complete, and click the SUBMIT or E-MAIL button on the form. *Adobe Reader 8.0 or newer is required (free download link available below). If you use a web based email such as Yahoo, Hotmail, G-mail, AOL, etc, the forms will need to be completed, saved on your computer and emailed as an attachment to frontdesk@pdxortho.com. Patient Medical History     Authorization for Disclosure of Medical Information     Patient Registration Form After sending, forms may be printed or saved for your records. Adobe Reader 8.0 or newer required. Note: Some versions of Google Chrome will not send PDF forms, in which case a different browser (Internet Explorer, Firefox, Safari, etc.) will need to be used.

Additional Forms - Dr. Feinblatt Patients Only © Copyright 2011, 2012 Authorization for Teaching Presentations - Dr. Feinblatt Only History of Present Illness - Dr. Feinblatt Only After sending, forms may be printed or saved for your records. Adobe Reader 8.0 or newer required. Note: Some versions of Google Chrome will not send PDF forms, in which case a different browser (Internet Explorer, Firefox, Safari, etc.) will need to be used.

Additional Patient Forms:

Credit Policy Form © Copyright 2011, 2012

• Patient Financial Responsibility form - Please read, sign and return it to the receptionist.

The following forms may be completed online and printed from your computer.

These forms MUST BE PRINTED. Do not save to a flash drive or CD (they save as a blank form, and our office is unable to print the form with your information showing). After completing the form online, please PRINT these forms and bring them to your appointment.

Regence Forms © Copyright 2011, 2012

• Blue Cross Blue Shield New Injury Form

Transfer Medical Records © Copyright 2011, 2012
    Please use these forms if a transfer of medical records is needed
    (This typically is not needed if the records are coming from your primary care physician).

• Records Release TO Oregon Orthopedic
• Records Release FROM Oregon Orthopedic

Notice of Privacy Practices

The above forms are in a PDF format, and you will need Adobe Reader 8.0 or newer to complete the forms.
Your computer may already have Adobe Reader installed, but if not the download is free.

To make an appointment at either office, please call 503.656.0836, or request an appointment, online.

MISSION STATEMENT
"Our physicians and staff strive to provide
the highest quality of orthopedic care to the
satisfaction of our patients