Patient Forms
Please choose one set of forms below. Download, print, and complete the forms, and bring them with you to your appointment.
If you wish, forms can also be submitted by email (info@kidsheartco.com) or fax (541-507-9181).
If your child has seen a different cardiologist in the past, please also complete a Release of Information form and send it to us or to your previous cardiology provider, so that we can obtain your child’s past medical records and be better prepared for your visit.
Visit Type
Choose One
New Pediatric Patient
Birth to age 18
New Adult Patient
Over age 18
New Fetal Patient
Pregnant Moms
New Preventive Patient
Combined Cardiology/Nutrition Clinic
Tipo de Visita
Escoja una de las siguientes opciones
Paciente Pediátrico Nuevo
Desde recién nacido hasta los 18 años
Paciente Adulto Nuevo
Mayor de 18 años
Paciente Fetal-Nuevo
Madres embarazadas
Paciente Nuevo-Prevención
Combinación de Cardiología y Clínica de Nutrición