Patient Forms

Learn about frequently used forms and information at Mosaic. Your appointment reminders will include links to access the forms electronically. Certain forms are also available from within your MyChart account.

Registration forms

Adult and Pediatric Registration Forms are available at any of our health centers, provided during an appointment or by calling us at 541-383-3005.

Patient Release of Information – Medical Records

Learn how to access your medical records at Mosaic.

Sliding Scale Discount Program form

Before filling out this application, read more about the Sliding Scale discount program

Sliding Scale Application

Need these files in a different format?

We are committed to making our information accessible to everyone. If you need this document in an alternative format, please call us at 541-383-3005 and we will provide it promptly.

Grievance form

Patients and others may submit a complaint with Mosaic verbally by calling the main Mosaic Phone number at 541-383-3005, in writing by completing the grievance form and returning it to any Mosaic site, or by mail.

Grievance form

Other forms and resources

Advance Directive Forms: Oregon Health Authority

Notice of Privacy Practices

MyChart FAQs

Learn how MyChart can help you take control of your healthcare information: detailed information with screenshots and video provided for easy access.

Go to MyChart FAQs

Preparing for your Mosaic visit

Everything you need to know about visiting Mosaic for the first time, or as a returning patient.

Go to Prepare For Your Visit