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 Paperwork: The documents below contain questions about your medical history and symptoms, so we have a better understanding of your current condition going forward. Also, you will find the welcome letter, registration, financial policy, new patient questionnaire, communication release, and HIPAA acknowledgment. They are listed by the location of your new patient visit. Please choose the appropriate form per location scheduled. IF YOU DO NOT HAVE YOUR PAPERWORK COMPLETED BY YOUR APPOINTMENT TIME YOU MAY NEED TO BE RESCHEDULED.
- 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.
- Letter to Specialists: This form may be delivered to your primary care provider regarding the prescription of medications.
New Patient Referral: If you are a referring office and would like to refer a patient to Willamette Pain, please use this form and fax the necessary documentation and insurance referral to 503-512-1220. Our New Patient Coordinator will review the information and contact the patient to schedule once everything is received.
- Follow Up Questionnaire(Monthly): Please expect to fill out the questionnaire at every visit. This is not the new patient paperwork. Please see above for that. We request that each patient check-in up to 15 minutes prior to their appointment. If you feel you may need more time or are unable to come early to complete the paperwork, please feel free to print and fill it out prior to your visit. Please fill out on the same day as the appointment if printed from the website.
- Quarterly Follow Up Forms– Starting January 2020, we will have our patients fill out this follow up packet quarterly (January, April, July, and October). Please feel free to print this from our site or arrive 30 minutes early during these months if you plan to fill these out in the office before your scheduled appointment. These are not new patient forms. Please see the above for New Patient paperwork.
Other forms that are of use to our patients include:
- Pre-Procedure Instructions: This form gives you instructions about how to prepare for a procedure at our clinic.
Forms for Allison Gullo, MD:
- New Patient Paperwork: New patient information for individuals working with psychiatrist Allison Gullo, MD.
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!