Form Selection

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Some quick housekeeping information first:

We take patient privacy very seriously. Any information submitted through these forms is saved using JotForm's HIPAA-secure storage and then downloaded directly to your chart. It will never be sent to third parties or used for sales or marketing. Further information about JotForm's security can be found here.

You can change display languages at will using the language selector at the upper right of the screen. Currently CFM offers all online forms in English and Spanish. If you speak another language we will be happy to provide an interpreter. Let us know if you need any assistance with the forms or would like them offered in an additional language.
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While we make every effort to keep our forms as short as possible, we understand that life sometimes gets in the way and you may not be able to finish a longer form in one sitting. There is a Save button at the bottom of the page on any form with more than five questions. A link will be sent to an email address you specify, which allows you to pick up where you left off.
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What forms do you wish to complete?
A welcome packet for Tracy Lenee Bluhm
A welcome packet for Erika Grantz
A Release of Information form
A Telemental Health Informed Consent form
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Thank you for your interest in Corvallis Family Medicine! Please call our office at 541-757-2400, option 7 for more information.
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Why are you filling out a form?
1. Corvallis Family Medicine is currently not accepting new patients
2. I want to become a patient of Behavioral Health.
3. I want to speed up check-in for my first appointment by completing a new patient packet ahead of time. This is only for approved patients with appointments
4. I would like to grant permission for a family member or friend to call on my behalf.
5. I would like to sign up for a Patient Portal account.
6. I want to update medical history information prior to an upcoming appointment.
7. I need to complete paperwork for an upcoming Annual Wellness Visit.
8.I want to request a copy of my medical records or have then sent to another entity.
9.I need to complete a migraine/headache questionnaire for Angie Bean, PA-C
10.I need to complete a weight loss program questionnaire.
11. I need to complete a Perimenopause/Menopause questionnaire
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