Clinic Forms and Documents

If you are a parent, guardian or family member of a patient and would like to receive a flu shot, please fill out this form: Flu Caregiver Registration Form.

You can bring completed forms with you, or to expedite your check in process, please complete and send through the New Patient Portal.

If you have billing related updates or inquiries, you can submit your question through the patient portal.

New Patient Packet
Adult Patient Release Form
Consent to Treat Form

Medical Release Form (from Sunset)
Medical Release Form (to Sunset)
Notice of Privacy
Financial Policy
Patient Portal Forms – Sign up for the patient portal by filling out these forms. Fill out one form per child seen at Sunset.

Developmental Screenings
M-Chat Questionnaire for Toddlers
9 Month Questionnaire
18 Month Questionnaire
24 Month Questionnaire
11+ Adolescent Questionnaire:

At each Well Child Check, once your child turns 11, the pediatricians at Sunset Pediatrics strongly recommend that your child complete an adolescent questionnaire. Per Oregon Health Authority guidelines, we use a well-studied and validated questionnaire called the SBIRT (CRAFFT & PHQ 2/9). The SBIRT is a universal screening that quickly detects anxiety, depression, substance use disorders, and the risk of developing them. It also provides insight and awareness regarding risky behaviors and can help your child’s pediatrician refer them to any additional help they may need.

We ask that your child completes the form in private, however, they will discuss the answers with their pediatrician. If you have any questions or concerns, please ask your child’s doctor.

The Oregon Health Authority is working to standardize billing and payment for all insurance payers. However, please be aware that the coding and billing policies for the SBIRT are a work in progress, and are currently billed separately from your child’s Well Child Check. This may result in a balance for the responsible party of up to $40.

Immunization Schedule
2022 Recommended Well Visits and Immunizations

Medical Chaperone Rule Requirements starting July 1, 2023
An Oregon Medical Board licensee must:

Offer to make a trained chaperone available who can be present for any:
- Genital and rectal examinations regardless of gender; and
- Breast examinations for patients who identify as female.

For any other questions, please click here to be taken to the FAQs page in regard to this requirement.