Forms

Forms

Intake Forms

CMC Intake Form (0-5 years)

CMC Intake Form (6-12 years)

CMC Intake Form (adult)

Policies, Procedures & Consent Forms

CMC Policies, Procedures & Consent Form

Medical Records

Release of Medical Records

Verification of Benefits
More information about Billing & Insurance can be found here.

Insurance Verification of Benefits Form (PDF)

We Accept

Please note this may vary for the Birth Facility:

• Aetna

  • Aetna Standard, Open Access, Aetna Premier

• ASH (Cigna)

• BCCP (Dr. English-Williams only)

• Care Oregon (Medicaid)

• OHP Open Card (Medicaid)

• CHP/Kaiser (Dr. Anderson-Lyon only)

• ODS/MODA

  • Connexus, Synergy, Beacon, OHSU PPO, OHSU Tuality,

• PacificSource

• Providence Health Plans

• Regence/BCBS

  • Participating, Preferred, Legacy LHP, RealValue, Blue High Performance Network

• United Healthcare

  Insurance Verification of Benefits Form: