PATIENT FORMS

Thank you for choosing Hope Orthopedics of Oregon for your orthopedic care.

To save time you may download, print and complete our required patient forms. Please remember to bring your completed forms, along with the following pieces of information to your scheduled appointment. If you do not complete these forms you will be able to complete them when you arrive at our office.

Don't forget to bring the following to your appointment:

• Photo ID
• Insurance Card
• Referrals (if required by your insurance)
• Co-Payments (if required by your insurance)

Forms

Please use the links below to review clinic information and download patient forms.

Note: The Medical Information Disclosure Authorization can be emailed directly to our
Medical Records Department.

Authorization for Verbal Communication of Protected Health Information to Family or Friends

Billing Information Form

Consent to Treatment for Minors Authorization Form

Good Faith Estimate

Good Faith Estimate Spanish

Medical Information Disclosure Authorization

MRI Screening Form

Notice of Privacy Practices

Notice of Privacy Practices Spanish

Orthopedic Health History

Orthopedic Health History Spanish

Please feel free to contact us at 503.540.6300 if you have any questions.