(503) 667-8878
Gresham Office
(503) 261-1171
Happy Valley Office
(503) 295-2546
Northwest Office
(503) 531-3434
Westside Office

Patient Registration

Authorization to Release Medical Records
The Authorization to Release Medical Records grants Metropolitan Pediatrics, LLC, permission to send, receive, or verbally exchange medical records with another person or practice of your request.
Genetic Privacy Notice
The Genetic Privacy Notice regards the decision whether to use your child’s health information or biological samples for future genetic research.
New Patient Packet
The New Patient Packet includes all of the forms required to become a patient of Metropolitan Pediatrics. Please review our Treatment Consent, Credit Policy, and Notice of Privacy Practices prior to your first appointment.
Notice of Privacy Practices
The Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. | en español
Patient Information
The Patient Information form is used to collect patient/parent demographic and insurance information. | en español
Patient Intake Form
The Patient Intake Form is a detailed questionnaire about your child and family's medical history. | en español
Treatment Consent
The Treatment Consent describes care at Metropolitan Pediatrics, including our confidentiality obligations, insurance agreements, appointment reminders, after-hours assistance, and grievance procedure. | en español

Behavioral Health

ADHD Evaluation Packet
The ADHD Evaluation Packet describes the steps taken to evaluate your child or teen for Attention Deficit Hyperactivity Disorder (ADHD). Parent, caregiver, and teacher responses provide important information that will assist us in better understanding your son or daughter's functioning in home and school settings.
Complete the packet and upload it securely to our Behavioral Health Team.
Behavioral Health Intake Packet
The Behavioral Health Intake Packet includes several detailed questionnaires needed for your first behavioral health appointment. Your answers will give our staff valuable insight into your child or teen's medical and family history, including any concerns related to sleep, attention, and concentration.
Complete the packet and upload it securely to our Behavioral Health Team.

Billing & Financial

Credit Policy
The Credit Policy outlines Metropolitan Pediatrics’ billing and financial policies. | en español
Financial Assistance Application
The Financial Assistance Application is a request to be considered for reduced monthly payments or discounts due to a recent change in financial circumstances or the inability to pay your bill.

MyHealth Patient Portal

MyHealth Proxy Access Request
The MyHealth Proxy Access Request gives a "proxy" (or person other than the patient) permission to access the patient's MyHealth account and medical information available within MyHealth. Proxy access is available to the following:
  • Anyone an adult patient permits to be a proxy (spouse)
  • Parent of a minor (birth parent or adoptive parent)
  • Legal guardian of a minor or adult
  • Parent/legal guardian of a developmentally disabled minor or adult patient

Return your completed request to your clinic, or fax it to Health Information Services at 503-466-1858.

2 Month Well Visit

Postnatal Depression Screen
The Postnatal Depression Screen is designed to identify parents who may be experiencing symptoms associated with Postpartum Depression. | en español

6 Month Well Visit

Postnatal Depression Screen
The Postnatal Depression Screen is designed to identify parents who may be experiencing symptoms associated with Postpartum Depression. | en español

9 Month Well Visit

9 Month ASQ
The Ages and Stages Questionnaire (ASQ) is designed to screen young children for developmental delays—that is, to identify children who need further evaluation and those who are developing typically. | en español

18 Month Well Visit

M-CHAT-R
The M-CHAT-R assesses your child's risk for autism spectrum disorders. Metropolitan Pediatrics screens all children at their 18-month appointment, and again at 24 months. | en español
18 Month ASQ
The Ages and Stages Questionnaire (ASQ) is designed to screen young children for developmental delays—that is, to identify children who need further evaluation and those who are developing typically. | en español

2 Year Well Visit

M-CHAT-R
The M-CHAT-R assesses your child's risk for autism spectrum disorders. Metropolitan Pediatrics screens all children at their 18-month appointment, and again at 24 months. | en español
24 Month ASQ
The Ages and Stages Questionnaire (ASQ) is designed to screen young children for developmental delays—that is, to identify children who need further evaluation and those who are developing typically. | en español

2½ Year Well Visit

30 Month ASQ
The Ages and Stages Questionnaire (ASQ) is designed to screen young children for developmental delays—that is, to identify children who need further evaluation and those who are developing typically. | en español

6-10 Year Well Visit

Sports Pre-participation Questionnaire
The Sports Pre-participation Questionnaire helps assess and ensure patients' safe participation in organized sports and other physical activities. | en español
Please check with your school to make sure they will accept the updated 2017 form. Both the 2010 and 2017 forms are accepted by the Oregon School Activities Association (OSAA); however, your school may have a preference. English (May 2010) | Español (Mayo de 2010)

11-13 Year Well Visit

Adolescent Annual Questionnaire
The Adolescent Annual Questionnaire is completed by all adolescent patients at least once a year because substance use and mood can affect your health.
Confidential Health History (11-13)
The Confidential Health History is a questionnaire completed by patients at each preventive exam during the 11-13 age range.
Pediatric Symptom Checklist
The Pediatric Symptom Checklist is a standardized screening tool, in which parents rate how they perceive their adolescent. | en español
Sports Pre-participation Questionnaire
The Sports Pre-participation Questionnaire helps assess and ensure patients' safe participation in organized sports and other physical activities. | en español
Please check with your school to make sure they will accept the updated 2017 form. Both the 2010 and 2017 forms are accepted by the Oregon School Activities Association (OSAA); however, your school may have a preference. English (May 2010) | Español (Mayo de 2010)

14-18 Year Well Visit

Adolescent Annual Questionnaire
The Adolescent Annual Questionnaire is completed by all adolescent patients at least once a year because substance use and mood can affect your health.
Confidential Health History (14+)
The Confidential Health History is a questionnaire completed by patients at each preventive exam during the 14-18 age range.
Pediatric Symptom Checklist
The Pediatric Symptom Checklist is a standardized screening tool, in which parents rate how they perceive their adolescent. | en español
Sports Pre-participation Questionnaire
The Sports Pre-participation Questionnaire helps assess and ensure patients' safe participation in organized sports and other physical activities. | en español
Please check with your school to make sure they will accept the updated 2017 form. Both the 2010 and 2017 forms are accepted by the Oregon School Activities Association (OSAA); however, your school may have a preference. English (May 2010) | Español (Mayo de 2010)

Additional Visit Questionnaires

12 Month ASQ
The Ages and Stages Questionnaire (ASQ) is designed to screen young children for developmental delays—that is, to identify children who need further evaluation and those who are developing typically. We do not require this form at your child's 12 month appointment; however, many parents choose to complete it and bring it with them to discuss their baby's development. | en español
36 Month ASQ
The Ages and Stages Questionnaire (ASQ) is designed to screen young children for developmental delays—that is, to identify children who need further evaluation and those who are developing typically. Our Northwest Office requires this form at your child's 3 year appointment. | en español