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500 SE Douglas Ave   | Roseburg, OR 97470 (541) 672-5721

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Patient Forms

Click on the links below to download your patient information forms. Please email completed forms to [email protected] or print and fill out your forms and bring them with you to your appointment.

New Patient Form (Adult)

New Patient Form (Under 18)

Notice of Privacy Practices

Acknowledgement of Receipt – Notice of Privacy Practices