Forms & Information


There are designated patient parking spaces in the lower parking lot in front of the clinic. Then take stairs or elevator to the clinic on the 2nd floor. 

Insurance card and co-pay:

  • Please bring your insurance card to each visit.
  • We will ask you to pay your co-pay at each visit.

Medication refills

  • You and your provider will review the medication you take at your first visit.
  • Please bring all medications and supplements to your first appointment.
  • Call your pharmacy for all your medication refills.


  • Lab draws may be completed without appointment at Providence Seaside Hospital Monday-Friday, 7:30 a.m.-5 p.m.

Test Results

  • We will call you with test results or send them to you in the mail.
  • We have an online patient portal called MyChart. We will help you sign up for MyChart at your first visit. After you sign up, you will be able to see your test results and health records on MyChart.

Same day visits

Before your first appointment

Complete these forms: (See links below)

  • Health History Form 
  • Medical Records Transfer Form

Review this information: (See links below)

  • Notice of Privacy Practice
  • Genetic Privacy Notice

Forms Instructions

Genetic Privacy Notice

Please review prior to the patient's first 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.