Patient Forms

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Making Registration Simple to Expedite Your Care

At Willamette Pain and Spine, we understand that filling out a series of medical forms when you’re feeling your worst is difficult. We know that taking the time out of your day to attend an appointment requires planning, effort, and perhaps a support person to accompany you. Our goal is to help you make the most of your time with us. For this reason, we now offer patient registration forms online.

For your convenience, these forms are available to print, fill out at home, and bring with you to your next appointment, along with your insurance card and photo ID.

The following documents can be downloaded by clicking on their name, below:

  • New Patient Questionnaire: This document contains questions about your medical history and symptoms, so we have a better understanding of your current condition going forward.
  • Patient Registration Form: On this form, patients record their address, insurance information and other basic housekeeping details for our office to keep securely on file.
  • Authorization to Release Protected Health Info: This form authorizes the release of your medical records to a provider or facility that you declare. All numbered entries on the form MUST be completed for the form to be considered valid. Incomplete forms will not be processed.
  • Financial Policy: We outline our financial policies in this document, so you are fully aware of acceptable payment methods, our missed appointment policy, and other valuable information.
  • Letter to Specialists: This form may be delivered to your primary care provider regarding the prescription of medications.

Other forms that are of use to our patients include:

Forms for Dr. Allison Gullo:

We are happy to mail these forms directly to your home at your request. If you are unable to complete your forms prior to your appointment, please arrive 30 minutes early so you can fill them out in the office. Have questions? Please feel free to contact us on the clinic line at 503-512-1212. We’re here to help!