Located in Portland, OR
503-234-1531
Dr. Susan Schmitt Forms
Dr. Susan Schmitt Forms
Dr. Susan Schmitt Forms
- Patient Registration Form - Complete form and submit
- Notice of Patient Privacy - Read, sign, and submit
- Financial Policy - Read, sign, and submit
- New Patient Form - Complete form and submit
- Auto Accident Only Form - Complete form and submit
- Authorization for Communication of Protected Health Information to Family And Friends - Complete form, sign, and submit (Optional)
- Authorization to Use/Disclose Health Information - Complete form, sign, and submit (Optional)
- Welcome to Our Office - Read only
- Patient Privacy Notice - Read only
Contact us today!
503-234-1531
At Takacs Clinic, we offer complimentary water and tea.