Appointments & Forms

If you would like more information about Oregon Interventional Pain Consultants, or to ask about the referral process for an appointment with a board-certified pain management physician, please call us.

Contact Oregon IPC

Phone: (503) 477-5205
Fax: (888) 972-4730

New Patients

In preparing for your upcoming appointment, ease your check-in process by completing our Patient Responsibility Form, Consultation Questionnaire, and Medical Records Release Form ahead of time. Please bring a copy of each completed form to your appointment.

Patient Responsibility Form

Consultation Questionnaire

Verbal Release for New Patients

Financial Policy Form

HIPAA Acknowledgement

Notice of Privacy Practices

Records Release Form

Driving Instructions

Current Patients

Follow Up Form for Current Patients


If you are a provider and want to refer a patient to Oregon IPC, please fill out the Doctor to Doctor Referral Form and fax demographics, chart notes and imaging to the fax number listed above.
Doctor to Doctor Referral Form

Make An Appointment

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