Patient Paperwork

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We look forward to getting to know you!

 

As you prepare for your first appointment with one of our doctors we encourage you to thoughtfully and thoroughly complete the appropriate Intake Form(s) listed below. Please bring your completed form with you to your appointment. If you are unable to download or print your intake form you may choose to arrive 15-30 minutes early to your appointment to complete a form in our office. 

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Please call our office if you have a question about which form is for you, (503) 445.7115.

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For patients who wish to bill insurance it is necessary to call their insurance and fill in this form prior to their appointment.​

• Insurance Verification Form

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For an Appointment with Dr. Keivan Jinnah, ND, MSOM, LAc:

• Clinic Policies Consent Form

• New Patient Intake Form

• Metabolic Assessment Form

• Pediatric Intake (0 to 5 years)

• Pediatric Intatke (6 to 12 years)

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For an Appointment with Dr. Mary Frazel, ND:​

• Clinic Policies Consent Form

• Adult Intake Form

• Pediatric Intake (0 to 5 years)

• Pediatric Intatke (6 to 12 years)

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For an Appointment with Dr. Lita Buttolph, DSOM, LAc:

• Clinic Policies Consent Form

• New Patient Intake Form

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