Patient Forms

New patients are encouraged to visit their Cascade Internal Medicine My Chart account to complete the patient registration, health history, and HIPAA information.

If you don't have an account, or you prefer not to use it, please download, print, and fill out the forms below. If you are unsure which forms you need for your visit, please call us at 541.318.0124.

New Patient Information & Medical History

• Patient Registration Form (PDF)
• Health History Intake Form (PDF)

Disclosure of Information

• Medical Records Request (PDF): Authorize us to receive medical information from a previous provider.
• Medical Records Release (PDF): Use this form to request a copy of your medical records.

Privacy Policy
We respect and appreciate your privacy. We follow general HIPAA (Health Insurance Portability and Accountability) guidelines. Please review this before your first visit. We ask that you complete, sign and turn in our "Acknowledgment and Consent" form to indicate you have received this information.
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• HIPAA Privacy Policy (PDF)
• Acknowledgment and Consent to HIPAA Privacy Policy (PDF)
• Personal Health Information Release (PDF): Use this form to notify us of all individuals that you would like for us to be able to discuss your private health information should they call into our office on your behalf. We cannot discuss any of your private health information without this information.

Find out more about membership today!

Call 877.888.5590, email [email protected], or complete this form to learn more.

"I love how my doctor really knows me. It's such a relief to know I can see my physicians or just get my physician on the phone when a health concern emerges."