Forms

These forms may be completed prior to your first appointment or you may simply complete them in the office at the time of your appointment. For the intake form, please list parent information if the patient is under the age of 18 or if the patient is an adult but one or more parent is responsible for payment.

For the release of information form, please list anyone with whom I may speak regarding your care. This might include a spouse, family doctor or therapist. If you do not complete the release form, I will assume that I may not speak to anyone regarding your care, UNLESS I feel you are a danger to yourself or others. Thank you!

- Registration form

- Release Form

 

Angelina Montoya, M.D.
Board Certified in Child, Adolescent
and Adult Psychiatry

Address:
2755 NW Crossing Dr. Ste 210
Bend, OR 97703

Phone: (541) 678-5652
Fax: (541) 306-4459

 
 

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