PATIENT REGISTRATION FORMS
We ask that all new patients download, print and complete a patient registration packet.
Should you have any questions, our staff will be happy to assist while completing your registration.
PDFs: You will need Adobe Acrobat Reader to view and print PDF forms. If you do not have this program, you may download it for free here.
Download a Patient Registration packet per provider:
- Dr. Husum (PDF)
- Dr. Linden (PDF)
- Dr. Cendejas (PDF)
- Dr. Hungerford (PDF)
- Dr. Murphy (PDF) Currently closed to new patients
- Dr. Schultz (PDF)
NOTE: Dr. Newton is by referral only. His patient registration packet is distributed by his care team. Please call our office for details at (541) 282-2200.
Please read our HIPAA Privacy Policy (PDF) before coming for your appointment.
On appointment day:
- With thousands of insurance and pharmacy plans available, and identity theft a potential risk, we need to confirm your identity and insurance coverage every time we see you.
- Please bring a photo ID, and your insurance card with you to your appointments at SOIM. If you have a prescription card, please bring this to your appointment as well.
- Please plan to pay your copay or your portion of the cost for your visit when you arrive for your appointment..
Copies of Medical records:
- If you would like a copy of your complete medical record, we will need a formal request from you, which must be completed in writing and signed by you or your authorized representative. For your convenience a Medical Release form PDF* can be downloaded and submitted via fax or to the address included on the form.
- Please allow 30 days for medical record requests. There is a small copying charge.