New Patient Form (download PDF)
If you are a new patient to Fanno Creek Clinic, please print this form, complete, and bring to your scheduled appointment.

 
Patient Survey Form (download PDF)
We at Fanno Creek Clinic take pride in being responsive to our patients’ needs.  If you have any comments or suggestions as to how we may improve the health care we provide our patients, please print out and complete the above form and either drop it off at the reception desk or mail it to:
 
Fanno Creek Clinic
Attn: Lisa Dietrich
2400 SW Vermont Street
Portland, Oregon 97219

Release of Medical Records Form (download PDF)
If you wish to have your medical information transferred to or from Fanno Creek Clinic, we require that you complete a Release of Medical Records form prior to having your information transferred.
 
  • Transferring information to Fanno Creek Clinic – if you wish to transfer you medical record information from another medical office or clinic to a health care provider at Fanno Creek Clinic, print and complete the above form and send it either by fax or by mail to your previous provider’s clinic.  Upon receipt of the form, your medical records will be forwarded to Fanno Creek Clinic.

  • Transferring information from Fanno Creek Clinic – If you are a current patient of Fanno Creek Clinic and want to have your medical records transferred to another medical office or clinic, print and complete the above form and either fax it to 503-768-9232 or mail it to:

Fanno Creek Clinic
Attn: Medical Records
2400 SW Vermont Street
Portland, Oregon 97219

 

Fanno Creek Civilian Conservation Corps Form (download PDF)
Please print out and complete the above form and either drop it off at the reception desk or mail it to:
 
Fanno Creek Clinic
Attn: Civilian Conservation Corps
2400 SW Vermont Street
Portland, Oregon 97219