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Patient Registration Forms
PHYSICAL THERAPY APPOINTMENT FORMS
Patient Rights and Responsibilities
We want to encourage you, as a patient at The Portland Clinic, to speak openly with your healthcare team, take part in your treatment choices and promote your own health and safety by being well-informed and involved in your care. Because we want you to think of yourself as a partner in your care, you should know your rights and responsibilities. We invite you, your family or your personal advocate to join us as active members of your care team.
Preventive Healthcare Guidelines
This resource is designed for the healthy patient without medical problems. These are our recommendations for routine exams, tests, counseling and vaccinations, designed to keep you at the best health possible. They are based on the U.S. Preventive Services Task Force recommendations, Centers for Disease Control and Prevention guidelines, and many other national and local resources.
Release of Information
Transferring Information TO and FROM The Portland Clinic: If you are transferring your medical record information from an outside physician’s office to a physician at The Portland Clinic or if you are a current Portland Clinic patient and need to have your records transferred to a non-Portland Clinic medical office, you will need to complete the Release of Information form and fax it back to our Release of Information Department at 503-620-5348 or mail it to The Portland Clinic, South Office (Attn: Record Release Department) 6640 SW Redwood Lane, Portland OR 97224.
Referring Patients to The Portland Clinic
If you are a provider and would like your patient to see one of our specialists, please complete the referral form* and fax it to our Patient Access Specialist: fax 503-214-4690, phone 503-802-6377. After we receive your referral, your patient will be contacted to schedule a specialist consult. If you are a patient seeking specialty care, please contact your Primary Care physician to refer you to The Portland Clinic. Many specialty physicians require diagnoses and chart notes before scheduling consultations.
* A complete referral contains the following:
Advance Directive Form
As long as you can speak for yourself, you are always in charge of your health care. But what happens if accident, illness or disability robs you of the ability to make your wishes known? You can take action now to insure your wishes are followed when you can’t speak for yourself by filling out an Advance Directive for Health care. Ask your provider for a booklet that contains a legal form which allows you to express your wishes for care, if you become unable to decide in the future.
NOTICE OF NON DISCRIMINATION
The Portland Clinic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.