Patient Forms

Preparing For Your Initial Visit

Welcome to Pine Springs Health, your committed partner in primary care. As a new patient, we need to gather some important information to ensure that we provide you the highest standard of personalized care. On this page you will find some essential forms that help us get to know you and your health better.

You can fill out this information via our E-CheckIn process through MyChart, or you can download each form, fill them out, print, and sign. Please bring these completed forms with you to your initial appointment.
If you prefer to fill out these forms in person, we will happily provide them for you to complete when you arrive for your initial visit.

Our team is looking forward to meeting you and playing an active role in managing your health. Thank you for choosing Pine Springs Health for your medical care needs in Bend, Oregon.

View our Notice of Privacy Practices here.

1. New Patient Registration

Download Registration Form

2. Communication Preferences

Download Communications Form

3. Patient Health History

Download Health History Form

4. Authorization to Release and Receive Protected Health Information

Download Records Request Form

Our Policies & Agreements

Below you will find downloadable versions of our patient agreements that we have all patients sign before their first visit with Pine Springs Health. These are here for patients to learn our policies, but there is no obligation to have signed these agreements before coming in to the clinic.
Please feel free to give us a call or check out our FAQ if you have any further questions.

1. HIPAA Notice of Privacy Practices & Consent to Treat
2. Financial Agreement
3. Philosophy on Controlled Substances
Download HIPAA AgreementDownload Financial AgreementDownload Controlled Meds Philosophy