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Olson Pediatric Clinic   503-635-3743
 

Contact Olson Pediatric Clinic

Patient Forms

The forms below are in Adobe PDF format. Please complete the forms online.

    • Step 1 - Complete form online
    • Step 2 - Save completed form to your computer*
    • Step 3 - Send completed form as an attachment via email

*You may also print the forms.

Advanced Computer Users: On most newer computers, with version 8 or newer Adobe Reader, you can send the completed forms directly from your computer (see EMAIL button in bottom right corner of each form). NOTE: The send feature works in MS Internet Explorer and Firefox. with the genuine Adobe Reader, but does not work in the pdf reader that comes with Safari or Google Chrome.

Authorization & Registration Forms, Policies, & Notices

Health History Questionnaire

Authorization to treat in the absence of parent or guardian

Authorization to Release Medical Records

Patient Registration Form (for minors)

Patient Registration Form (18 yrs and over)

Olson Pediatric Clinic Financial Policy

 

Get Adobe ReaderThe above forms are PDF files. They can be viewed with Adobe Reader. If your computer does not have Adobe Reader installed you can download the free software here.


 

 

 
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Olson Pediatric

Olson Pediatric Clinic
16463 Boones Ferry Road, Ste 400
Lake Oswego, OR 97035
503.635.3743

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