Call for Appointment,
24/7 Nurse Advice


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in Central Oregon


CALL for Appointment, 24/7 Nurse Advice


FIND Our Clinics in Central Oregon

COPA Patient Forms

Expedite your child’s care by downloading these forms to complete before you arrive. If you have any questions, please feel free to call us. 

New Patients to COPA

Well-Child Check Questionnaires

Release Medical Records TO COPA from another Provider

Release Medical Records FROM COPA to another Provider

OSAA Sports Physical Forms and Medical Forms 

Behavioral Healthcare Vanderbilt Forms

MyHealth | MyChart E-Records Proxy Access Request

Payment Hardship Application

Consent by Proxy Authorization Form  
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 at those visits 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 from the parent or guardian to administer care.

SICK VISITS: A person who is 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 the visit or treatment to occur: Consent by Proxy Authorization Form  

COPA is able to assist you with your application for Oregon Health Plan. Please complete this document to finalize your enrollment. Oregon Health Authority Consent form for OHP Application.

Bienvenido a COPA

Autorizacion Para Solicitar Registros Medicos De Fuera

Transferir los Registros de la COPA

OHA Consentimiento [Oregon Health Plan-OHP]

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


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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