5295 NE Elam Young Parkway, Suite 180, Hillsboro , OR 97124
(503) 615-0960
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Patient Forms

Patient Forms

Please click on the links to download our forms:

New Patient Forms:

 

  • New Patient Demographics, Insurance, PHI
  • Medical History Form
  • Consent to Treatment & HIPPA Acknowledgement
  • Hicken Medical Clinic Financial Policy

Optional Forms:

 

  • Authorization to Share Protected Health Information
  • Medical Records Release and Request Form
  • Credit Card on File Agreemen
Pay Online Cancellations

Business Hours

Mon - Thu
7:00 am - 5:00 pm
Friday
7:00 am - 1:00 pm
Sat - Sun
Closed

Explore

 

  • About our clinic
  • Medical Providers
  • Patient Forms
  • Pay Online
  • Privacy Policy
  • Cancellations

 

The Clinic

Maps & Directions

Contact Us

Phone: (503) 615-0960
Fax: (503) 615-8572

Monday-Thursday: 7am-5pm
Friday: 7am-1pm
© 2022 Hicken Medical Clinic. All rights reserved.
© Hicken Medical Clinic. All rights reserved.

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