Patient forms

For your convenience, you can complete the forms below by downloading, printing, filling them out and bringing them with you to your first visit.

Release of information

In order for WVCI to release a patient’s confidential medical records to a third party, the authorization form below must be completed and signed by the patient. The authorization form can be mailed, hand-delivered, or faxed to either location listed on the form (Eugene or Springfield), to the attention of: Medical Records Department.

Patient binder forms

You will receive a new patient binder at your first appointment. If you need additional pages for the My Health Care or My Journal section, we have provided blank forms for your convenience, here.

Gynecologic oncology forms

For medical professionals