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

  • Providence Medical Group Health History Form
  • Medical Records Transfer Form

Review this information

  • Notice of Privacy Practice

Forms Instructions

Health History Form - Southeast (Adult 18+yrs.)

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

Medical Records Authorizations

Providence Health & Services provides access to medical records from our hospitals and other medical facilities in Oregon to patients and their authorized representatives.

Medical Records Transfer Form

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

Notice of Privacy Practices

Please review prior to the patient's first appointment.

Well child checklist

A list of developmental questionnaires from birth to age 21. 

Well child checklist-Spanish

Una lista de los cuestionarios de desarrollo desde el nacimiento hasta los 21 años.

Proprietary Health Article

Providence family clinics treat food insecurity; Nutrition, the foundation of health.

Southeast 82nd Avenue and Milwaukie Clinics ask parents if they have enough money to buy food for their children. A Patient Navigator then interviews the family and connects them with community resources like The Oregon Food Bank to provide food security.