New Patients

Your first visit to Pacific Sleep Program involves a few special steps so that we can get to know you. To understand what to expect, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, more. You can even save some time by printing out and completing the new patient forms in advance of your appointment. We ask that in office new patients arrive 30 minutes prior to their appointment time.

Mission Statement

Our practice is working together to realize a shared vision of uncompromising excellence in medical care.

To fulfill this mission, we are committed to:

• Listening to those we are privileged to serve.
• Earn the trust and respect of patients, profession and community.
• Exceed your expectations.
• Ensure a creative, challenging and compassionate professional environment.
• Strive for continuous improvement at all levels.

Referring Providers

Pacific Sleep Program welcomes both new patient referrals and direct sleep study referrals. Please use one of the forms below and fax to our office at (503) 228-7293. If a direct referral for a sleep study is requested, please send accompanying chart notes and copies of insurance cards so that we can obtain appropriate prior authorizations from the patient’s insurance. We are on EPIC and can access charts through Care Everywhere.

Referral Forms

To be submitted by referring/medical staff only. If you are a new patient, wanting to schedule a consultation, please contact 503-228-4414, option 3.

• Pediatric Referral Form PDF | Online
• Adult Referral Form PDF | Online

Patient Forms

Secure online forms:

• Adult New Patient Questionnaire
  
• Pediatric New Patient Questionnaire
• Authorization to Release PHI
• Conditions of Registration
• Conditions of Registration for Direct Referrals.

 In order to view or print the forms below, you will need Adobe Acrobat Reader installed.  Click here to download it. 

Please fill out these forms so we can expedite your first visit:

• Adult New Patient Questionnaire 
• Pediatric New Patient Questionnaire 
• Follow up Questionnaire 
• Epworth Sleepiness Scale 
• Sleep Diary

• Conditions of Registration
• Consent to Treat Minors 
• Medical Release of Information 
• Portland Office Location Map 
• PAP Cleaning Instructions 

What to expect

Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.

  Directions

Our Portland office is located at the Barnes Road Professional Campus in building A.

11790 SW Barnes Rd, Building A, Suite 330 Portland, OR 97225