By appointment only — Call (503) 667-9300 or contact us online to schedule  ·  Mon–Thu 8 AM–5 PM  ·  Fri 8 AM–12 PM
Home Intake Forms
New & Established Patients

Fill Out Your Paperwork
Before Your Appointment

Save time at your visit by completing your intake forms online ahead of time. Select the form that matches your appointment type below and submit securely through our patient portal.

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Come to your visit
Patient Registration Form
Urgent Care Registration
MVA Patient Registration
Primary Care Registration
Established Patient — Urgent Care
Established Patient — Medical Update
Testosterone Program Registration
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Patient Forms

Select Your Form Type

Click the button on the form that matches your visit type. Not sure which one? Call us at (503) 667-9300.

New Patient Registration

New Patient
Urgent Care Registration

For new patients coming in for urgent medical care. Includes personal information, medical history, insurance details, and chief complaint fields.

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Secure
New Patient
MVA Patient Registration

For new patients seeking treatment following a motor vehicle accident. Includes accident details, injury description, and insurance/liability information.

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New Patient
Primary Care Registration

For new patients establishing primary care with Dr. Hansel. Includes full medical history, current medications, family history, and lifestyle information.

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Secure

Established Patient Forms

Established Patient
Established Patient Urgent Care Form

For existing patients requiring urgent care. A shorter form to capture your current complaint and any updates to your medical history since your last visit.

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Established Patient
Established Patient Medical Update Form

For existing patients with updates to their health information — new medications, conditions, or changes in lifestyle since their last appointment with us.

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Program Enrollment
Testosterone Program Registration

For patients enrolling in Dr. Hansel's Testosterone Replacement Therapy program. Covers hormone history, symptoms, goals, and consent for TRT treatment.

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Secure
Not Sure Which Form?

We're Happy to Help

If you are unsure which form to complete, simply call our office and a member of Dr. Hansel's team will point you in the right direction. We are available Monday–Thursday 8 AM–5 PM and Friday 8 AM–12 PM.

Call (503) 667-9300 Send a Message