Primary Care Forms

Please call our intake offices (971-202-5566) before you complete the primary care application form (below) so we can confirm that we can help you. Be sure to have your current insurance card and patient address information when you call.

• Complete all information on this form. Missing information may delay the admission process.
• Return form by mail, fax or email. If returning by email, please contact our office so you can encrypt your paperwork before sending as email transmissions may not be secure.
• We will contact you if we have further questions or when we are able to offer you an appointment. Please keep seeing your current provider until we have completed an intake visit with you.

• Registration form
• Mail: Intake OfficeHousecall Providers
  5100 S Macadam Ave, Suite 200
  Portland, OR, 97239Fax: (971) 202-5555
  Email: intake@housecallproviders.org

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Housecall Providers document links:

• Our Services 
• Types of visits
• What to expect
• Symptoms and what to do
• Patient Portal FAQ
• Interpreter services