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Olson Pediatric Clinic
  • Home
  • About Us
  • Services
    • Newborns
    • Well Child
    • Sick Child
    • Mental Health Services
    • Circumcision
  • Providers
    • Dr. Laura Dart
    • Dr. Elizabeth Graff
    • Dr. Mark Musselman
    • Dr. Richelle Neal
    • NP Sherry Sweeney
  • Patient Info
    • Billing and Insurance
    • Patient Forms
    • Medicine Refills
    • Resources
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Patient Forms

The forms on this page are in Adobe PDF format. Please print out and complete the forms, and bring them with you to your appointment.

New Patients

Patient Registration form - Minors
New Patient History form (age 0-5 yrs)
New Patient History form (age 6-11 yrs)
New Patient History form (age 12-18 yrs)
Records Release TO Olson Pediatrics
Financial Policy

Existing Patients

Camp and Athletic participation form
Records Release FROM Olson Pediatrics
Records Release TO Olson Pediatrics
Patient Registration form - 18yrs+

Proxy Forms for All Patients

Proxy Form - Minor
Proxy Form - 18+

OLSON PEDIATRIC CLINIC

16463 Boones Ferry Road, Ste 400
Lake Oswego, OR 97035
503.635.3743
Directions to Our Clinic

Notice of Nondiscrimination

Olson Pediatrics complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sexual orientation.
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ATTENTION: If you speak a language other than English, free language assistance services are available to you. Call 503.635.3743.

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