Admission Forms

Cedar Hills Hospital & Outpatient Services value you and your time. We have made assessment forms available for you to complete before your arrive for your appointment in order to expedite your appointment. Please complete the forms below and bring the packet of information with you when you arrive for your assessment.

Patient Information (In Process, not yet available)

A form providing brief demographic information about yourself in order for Cedar Hills to better serve you. Insurance information is requested on this form so please bring your insurance card with you, along with this form completely filled out.

Notice of Privacy Practices

We will respect your privacy at Cedar Hills Hospital & Outpatient Services. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this form carefully.

Release of Information

In order to communicate with others about you or your care at Cedar Hills, we require a signed release of information. This includes family members, professional referral sources / medical providers, friends and anyone else you would like to be able access information about your care and treatment. Please complete this form and bring it with you to your appointment. If you do not want anyone to have access to your information we still require a signed release of information, just leave the area requesting names blank.

PROFESSIONALS

If you are a professional referring a patient to Cedar Hills Hospital or Cedar Hills Outpatient Services, please take a moment to complete a referral form and fax to our admissions department at 503.535.7370 at the hospital or 971.228.8018 at outpatient services; or you can email the form to [email protected].

*For assistance completing these forms please contact the Admissions Department at 503.944.5000