New Patient Forms

Download, complete, and bring these forms to your first visit to save time at check-in.

Privacy Notice, Permission to Treat & Patient Policy Agreements
Combo form · Required for all new patients

PDF

Policies and Procedures at Columbia Basin Pediatrics
Updated April 2026

DOCX

General Consent to Treat a Minor
2026 Version

DOCX

13–18 Year Old Self Consent Form
For adolescent patients

DOCX

HIPAA Release of Information — Adult
Updated April 2026

DOCX

Release of Billing Information & Assignment of Benefits
Updated April 2026

DOCX

Records Release Form
February 2026

PDF

Solicitud de Divulgación de Registros Médicos
Records Release — Spanish version · 2026

DOCX

Pediatric Symptom Checklist — Ages 5–10
PSC · psc 5-10

PDF

Pediatric Symptom Checklist — Ages 11–20
PSC · PSC 11-20

PDF

Note: Word documents (.docx) require Microsoft Word or Google Docs to open. Call (509) 946-7332 for assistance.