541-201-3173 admin@ashlandcare.com

Forms

New Patient

New Patient Forms

In order to help save you time on your first visit I have included these patient information forms that you can download, print and fill out at home prior to appointment. If you’d like to submit these forms online, please download and fill out either the New Patient Forms Packet or the OHP New Patient Forms Packet. Once completed, please return to this page and submit the form(s) using the secure file transfer form below.

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New Patient Forms Packet

  • Patient Info Form
  • Adult Patient Checklist
  • Patient History Form
  • Previous Medications
  • Patient Rights And Responsibilities (Consent to Treat)
  • Authorization to Disclose Health
  • Information
  • Privacy Notice Acknowledgement

(OHP) Oregon Health Plan –
New Patient Forms Packet

  • Patient Info Form
  • Adult Patient Checklist
  • Patient History Form
  • Previous Medications
  • OHP Patient Rights And
  • Responsibilities (Consent to Treat)
  • Authorization to Disclose Health Information
  • Privacy Notice Acknowledgement

“All disease begins in the gut.”

HIippocrates

Contact Us

Please use this form to submit your filled out new/current patient forms.