Forms & Information

Providence Medical Group wants to help ease the way of our patients by providing new patient medical forms and privacy notice information in advance of their first visit. 

Please review all of the information below and complete the necessary forms prior to any patient’s first appointment to allow for quick and easy processing.

Complete these forms: (See links below)

  • Providence Medical Group Health History Form 
  • Medical Records Transfer Form
  • Family and Friends Authorization Form

Review this information: (See links below)

  • Notice of Privacy Practice
  • Genetic Privacy Notice


Forms Instructions

Family and Friends Authorization Form

Complete this form to allow family and friends to speak to the clinic and the patient's doctor on the patient's behalf. 

Genetic Privacy Notice

Please review prior to the patient's first appointment.

Health History Form - Southern Oregon New GYN Annual Exam

Please complete this medical history form prior to the patient's appointment.

Health History Form - Southern Oregon New OB Pregnancy

Please complete this medical history form prior to the patient's appointment.

Health History Form - Southern Oregon Return GYN Annual Exam

Please complete this medical history form prior to the patient's appointment.

Health History From - Southern Oregon New GYN Exam

Please complete this medical history form prior to the patient's appointment.

Medical Records Transfer Form

Complete this form to transfer personal medical records from another doctor or hospital to our office.

New Guidelines for Mammography Screening

Breast health experts at Providence Health & Services recognize the importance and complexity of counseling women on breast health and screening recommendations. In November 2009, the US Preventive Services Task Force issued updated guidelines for breast cancer screening. These new recommendations have been met with uneven acceptance from various foundations, professional organizations and breast health providers.

We have reviewed these new recommendations carefully and have engaged a number of concerned providers, physicians and women’s health advocates in order to gain consensus around this important issue. In general, Providence endorses the thorough, professional and evidence-based effort put forth by the USPSTF and recognizes these are difficult issues to analyze.

Notice of Privacy Practice

Please review prior to the patient's first appointment.

Proprietary Health Article

Medications that are Safe During Pregnancy

Women who are between four and 12 weeks pregnant may safely take the following over-the-counter medications. Follow all directions on the container for adult dosage and usage instructions.

Recommended Resource

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Healthwise Decision Point: Should I bank my baby's umbilical cord blood?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Healthwise Decision Point: Should I get pregnant when I have diabetes?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Healthwise Decision Point: Should I have an early fetal ultrasound?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

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