Patient Center

Patient Forms

Interested in becoming a patient of WellSpring Family Practice? Please stop by our office and pick up your patient forms packet OR print and complete the patient forms packet below and return to our office.

Once your paperwork has been received and your information entered, we will call you to schedule an appointment. WellSpring Family Practice looks forward to caring for you and your families medical needs.

New Patient Packet

• Patient Forms Packet

Individual Forms

If you need an individual form found in the Patient Forms Packet above, please choose that form from the following list.

• New Patient Information
• Intake Questionnaire
• Preventive Health Evaluation
• Authorization to Disclose Medical Information
• Financial Agreement
• Appointment Cancellation & No-Show Policy
• Notice of Privacy Practices

Insurance Accepted

If you don't see your plan listed, please contact our office. The managed care health insurance market changes rapidly, and specific coverage questions should be discussed directly with your insurance company or our knowledgeable staff.

• CareSource - MedAdvantage
• Regence - MedAdvantage
• Oregon Health Plan - Medicaid
• AllCare - Medicaid
• Blue Cross / Blue Shield Plans
• Providence Health Plans
• Pacific Source Health Plans
• MODA Health Plans