Thank you for using our secure online forms. Please fill out as much information as you can, but leave blank any fields that don't apply to you. When you are finished, be sure to hit the submit button at the bottom of the form and close the browser window to ensure privacy of your data. If you have any questions, please call us at (503) 444-7639. We can always change the data in the office if you are unsure about what to enter in any of the fields.