Patient Forms

Download patient forms below

Northwest Gastroenterology Patient Forms:

Thank you for choosing Northwest Gastroenterology Clinic. Whether you are a new patient, returning patient, or needing to request a copy of your medical record; you can find all of our patient forms here. All forms are also available in the office or by calling 503-229-7137.

Video Visit Information –

Portal Agreement

New Patient Office Visits:

Below you will find our new patient forms. Please print the forms and bring them completed to your first appointment.

HIPAA Notice of Privacy

New Patient Questionnaire

Financial Policy

Portal Agreement

Returning Patients Office Visits:

If we have seen you for an appointment within the last three years, please print and complete the form for our returning patients below.

Follow Up Questionnaire

Portal Agreement

Patient Procedures:

If you are a patient coming in for a direct access procedure, please print the forms and bring them completed to your procedure.

New Patient Questionnaire

Financial Policy

Patient Rights

HIPAA Notice of Privacy

Advance Directive (Oregon)

Portal Agreement

The following procedure forms are for review only. You do not need to print and sign these in advance. They will be provided for you to sign at the time of your procedure:

Anesthesia Consent

COVID Informed Consent

Procedure Consent

Medical Records:

Please print and complete the release of information and return to our medical records department.

Authorization to Release Information

Authorization to Release Records from Northwest Gastroenterology

Authorization to Release Records to Northwest Gastroenterology

Notice of Privacy Practices & Nondiscrimination:

Notice of Privacy Practices

Notice of Nondiscrimination

HIPAA Notice of Privacy