Patient Forms

For privacy reasons, please do not email the following forms. To provide your information securely, click each of the following buttons that say “submit online form” and follow the instructions by completing the form fields, then hit “submit” at the end of each form. Please be sure to complete and submit all forms.

Alternatively, you can download, print, complete the forms by hand, then mail or drop off the forms at our clinic, located at: Journey Family Medicine 995 Willagillespie Road, Ste. 300, Eugene, OR 97401

Journey Family Medicine will coordinate with other facilities on your behalf for the release of health information once you have submitted your completed form(s).

Pre-Registration

Submit Online Form
Download & Print Form

New Patient Information Form

Submit Online Form
Download & Print Form

Medical History Form

Submit Online Form
Download & Print Form

Office & Financial Policy Form

Submit Online Form
Download & Print Form

Authorization for Release of Health Information Form

Submit Online Form
Download & Print Form