Helpful Forms: Physician Practice and Medical Records

If you would like to become a new patient, please complete the following forms and return them to our office. Our physicians will then review your medical history to ensure that we can provide the level of care that you need. You should expect a call from our office staff within 2 business days of returning your registration forms.

**Please note that as a group we have decided not to participate in chronic narcotic pain management.

New Patient Information Form

If you would like our team to coordinate care with another physician practice please complete the form below to authorize release of your medical record, or the authorization for another physician practice to disclose information to us:

Permission to Share Information
Request Records from Stayton Family Practice
Request Records to Stayton Family Practice from your Previous Provider(s)

Note: To download Adobe Acrobat Reader for free, click here.