Registration documents

Information for Prospective Patients

The following is the Information for prospective patients. Please click the .pdf link to launch the form.

PDF icon Info for prospective patients.pdf

 

Patient Registration - To Fill Out

The following is our patient registration form which will share with us your contact information and allow us to care for you.

Please download and fill in the blanks. It is form-fillable in Adobe or Preview. You may print it out and bring it with you to the appointment, or you may save it and email an attachment back to us at [email protected] or [email protected]

If it is filled out in advance, your appointment should move along more quickly.

PDF icon Patient Registration FF.pdf

 

Financial Policy - To Fill Out

The following is our Financial Policy which we ask you to sign that you have read it.

Please print, fill out, scan, and email back [email protected] or jody@voicedoctor.net, or just bring to the appointment.  We will soon make this form fillable as well.

If it is filled out in advance, your appointment should move along more quickly.

PDF icon Financial Policy.pdf

 

Referring Physician Form - To Fill Out

The following is the referring physician form.  Please note the person having referred you to us.  As well, please add any physician or other provider you might want to learn what went on at your appointment.  If you would like a copy of the visit notes Dr Thomas will prepare, please note that on this form.  We also ask you to make note of any other person you would allow us to talk to about your care, even a family member. Otherwise, we would only talk with you.

Please print, fill out, scan, and email back to [email protected] or [email protected], or just bring to the appointment.  We will soon make this form fillable as well.  

If it is filled out in advance, your appointment should move along more quickly.

PDF icon 5_Ref MD 2015-03-12.pdf

 

Voice History - fillable

Our voice history form tells us about your troubles including details that assist us in your care.

Please download and fill in the blanks. It is form-fillable in Adobe or Preview. You may print it out and bring it with you to the appointment, or you may save it and email an attachment back to us at  [email protected]

If it is filled out in advance, your appointment should move along more quickly.

PDF icon H&P fillable.pdf

 

Notice of Privacy Practices

The following is our Notice of Privacy Practices pamplet - HIPAA.

PDF icon PrivacyPractices2014.pdf

 

Directions to and from our Office with Maps

We are located in Portland, Oregon. Check out the Google map or click the .pdf link to launch the document, which also contains directions.

PDF icon 2_Driving Map 2015.pdf