• Additional Forms and Resources
    • Below are additional forms that you will also be asked to complete on your first visit. To save time, feel free to print these out and complete them as well. Make sure you bring them to your medical or dental appointment.
  • Authorization to Release Protected Health Information
  • Notice of Privacy Practices
  • National Health Service Corps Promise
  • Health Records
    • If you would like to request copies of your Mosaic Medical medical or dental records, please complete the release of protected health information form (link above) and fax it to: 541-383-1883. You may fax dental or medical records to the same number.
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