Forms

New patient forms for Dr. Bassett

All patients must have the following forms signed and completed prior to first visit:

  1.  New Patient Intake Form OR  New Patient Intake Form – Pediatric
  2. Office Policy Agreement
  3. Notice of Patient Privacy
  4. Insurance Registration Form
  5. Insurance Verification Checklist

If you have medical records from other practitioners that would help us with your care, please download and complete the Release of Records Form.

Note: Follow-up with your provider from whom you’ve requested records to make sure they’ve been sent before your first visit. In our experience, this can sometimes be a timely process.

New Patients

At this time, Dr. Bassett is accepting new patients. Please contact us at (971) 231-7987 or info@vitaliapdx.com to schedule an appointment.