541-389-6313

Call for Appointment,
24/7 Nurse Advice

Locations/Hours

Find Our Clinics
in Central Oregon

541-389-6313

CALL for Appointment, 24/7 Nurse Advice

Locations/Hours

FIND Our Clinics in Central Oregon

COPA Patient Forms

Here you’ll find the forms we use to help expedite your child’s care. If you have any questions, please feel free to call us. You’re welcome to download the forms and fill them out before you arrive for your appointment.

New Patients to COPA

Well-Child Check Questionnaires

Release Medical Records FROM COPA to another Provider

Release Medical Records TO COPA from another Provider

Sports Physical Forms Approved by the OSAA

Behavioral Healthcare Vanderbilt Forms

CONSENT BY PROXY FOR MEDICAL TREATMENT | A parent or appointed guardian is required to accompany their child, 14 years or younger, to the child’s annual well-exam and for any vaccinations. The provider will inform the parent or guardian about the health of the child, discuss issues important to the patient, and in some cases COPA must receive permission to administer care. A person authorized by the parent or guardian to provide consent for medical treatment may accompany the child for sick visit only, however, the following form must be completed and delivered to COPA for treatment to occur.   Consent by Proxy for Medical Authorization

FORMULARIOS EN ESPANOL

Bienvenido a COPA

Autorizacion Para Solicitar Registros Medicos De Fuera

CONSENTIMIENTO DE PROXY PARA EL TRATAMIENTO MÉDICO | Se requiere que un padre o tutor designado acompañe a su hijo, de 14 años o menos, al examen de bienestar anual del niño y para cualquier vacuna. El proveedor informará al padre o tutor acerca de la salud del niño, discutirá temas importantes para el paciente y, en algunos casos, COPA debe recibir permiso para administrar la atención. Una persona autorizada por el padre o tutor para proporcionar el consentimiento para el tratamiento médico puede acompañar al niño para una visita por enfermedad solamente, sin embargo, el siguiente formulario debe completarse y entregarse a COPA para que se realice el tratamiento.  Autorizacion Por Consentimento Del Representante

PRIVACY POLICIES

COPA offers pediatricians in Bend and Redmond, Oregon

©2018 Central Oregon Pediatric Associates | COPA is a 5-Star medical home and the region's largest provider of pediatric health care for children, from newborn through high school.
Open 7 days a week to serve our community with four locations, extended hours and 24/7 Nurse Advice.

WEBSITE PRIVACY STATEMENT: When you visit this site, "website cookies" are used to store small amounts of meta data that will make your web browsing experience more efficient for you.This information is collected by COPA for website statistical analysis only. The cookie does not contain personal details. Depending on the browser that you use, you can set your preferences to block/refuse cookies, and/or notify you before they are placed. Information that you've opted to send COPA through the Contact  Message Form is private to COPA only and is used for the purpose of communication and administration within the medical practice to serve patients. 

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