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Please click on the links below to download and print forms to complete prior to your appointment.

Authorization Form - Pertains to issues regarding treatment.  It needs to be initialed at each section.

Patient History - Please answer questions about your current physical condition and any other pertinent medical conditions.

Notice of Privacy Practices
- This describes how medical information about you may be used and disclosed.

Time of Service Agreement - This form is for those who do not have insurance. We offer a reduced rate paid at the time of service.

Insurance list

The forms on this site are provided in Adobe Acrobat PDF format.
You will need a copy of Acrobat Reader in order to access and print out these forms.

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3016 NE Broadway • Portland, OR 97232 • Ph 503.287.6636 • Fax 503.287.4044
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