Patient Forms

New Patient Forms

If you are a new patient to Fanno Creek Clinic, please print out and complete the New Adult Patient Forms and bring them to your scheduled appointment. 

New Adult Patient Forms (pdf)

Download

Patient Survey Form (pdf)

Download

Medical Release and Privacy Practices

At Fanno Creek Clinic we take pride in being responsive to our patients’ needs.  If you have comments or suggestions as to how we may improve the health care we provide you, 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: Administration 

2400 SW Vermont St. 

Portland, OR 97219 

Consent to Leave Personal Health Information by Voicemail (pdf)

Download

Notice of Privacy Practices (pdf)

Download

Release of Medical Records Form (pdf)

Download

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 St.

Portland, OR  97219


                                                              

Patient Portal Access

Patient Portal access is now available. In order to sign up, visit our front desk and inform them that you would like to register for the Patient Portal. You will then be provided with a Patient Portal Agreement which will need to be signed and then you will be given an access code to register your account online. In order to protect your privacy and access to your medical information, we cannot give the access code over the phone and it will only be provided in person. 

FCC Patient Portal Set Up Instructions (pdf)

Download

Currently, the Patient Portal offers the following information: Drug  Allergies, Lab Results, Problem List, Medications, and Messaging with your PCP. 

 

***Please note that Messaging is to be used only for non-urgent, non-life threatening communication. Messaging is not intended for scheduling requests and if you have an urgent or life threatening issue, call 911 or go to the nearest emergency room. Messages may be screened by administrative staff before being forwarded to your health care provider. Normally, you will receive a reply to your message within 3 business days. When a faster response is required, call your health care provider or visit FCC. At the discretion of your provider, any or all secure messages may become part of the electronic health record.***    

  

To review the terms before your visit, please print the form below and return it signed to the clinic during your next visit. 

Patient Portal User Agreement (pdf)

Download

Patient Portal FAQ (pdf)

Download

Once on the site, click on Activate Your Account and enter your Access Code in order to register your account. If you have signed up for the FCC Patient Portal and would like to opt-in for patient notifications, please view the following document 

FCC Patient Portal Notifications (pdf)

Download

Various Forms

FCC Pet Policy (pdf)

Download