patient forms

click to download

teal down arrow

Below you will find all necessary forms for general radiology and interventional radiology.

General Radiology

i

Hawaii Medical Release Authorization

i

Oregon Medical Release Authorization

i

CT Patient History Questionnaire

i

Lung Cancer Screening

i

MRI Breast Patient Questionnaire

i

Nuclear Medicine Thyroid Questionnaire

i

SITZMARK

i

MRI Safety Screening

Interventional Radiology

i

Adult History

i

Sexual Health Inventory for Men

i

Low Back Pain & Disability (RMQ)

Have an invoice or outstanding balance?

Login here to pay your bill online.

PAY YOUR BILL

Adventist Health Portland

10123 SE Market Street
Portland, Oregon 97216
503.251.6137

Gresham Imaging Center

831 NW Council Drive
Gresham, Oregon 97030
503.251.6137

Clackamas Medical Plaza

10151 SE Sunnyside Rd Ste 100
Clackamas, Oregon 97015
503.251.6137

Adventist Health Columbia Gorge

1700 E. 19th Street
The Dalles, Oregon 97058
541.296.7251

QUICKLINKS

Services & Procedures

Interventional Radiology

Make A Payment

SCHEDULING & BILLING

Scheduling (Greater Portland): 503.251.6137

Scheduling (Columbia Gorge): 541.296.7700

Billing: 888.793.3525

PARTNERS

Adventist Health Portland

Adventist Health Columbia Gorge

Oregon Health & Science University