Electronic Forms Available and Preferred
Please note that all of the following forms and documents are also available electronically through the Charm portal and this is how I prefer to receive them. Required forms are generally sent to you automatically upon scheduling and are specific to your visit type. Please log in to the Charm portal and navigate to the Questionnaires section to complete your forms electronically. Make sure to click on SUBMIT after completing each questionnaire to send it to me. I am unable to review your forms until they are submitted.
If you don’t see any Questionnaires in your Charm portal or you need a form and it has not been sent to you, please message me through the portal or call/text me at 503-987-3622 to have a form sent to you electronically.
Need Paper Forms?
If you prefer to complete your paperwork on paper, please print, complete and sign the following forms. You may use a pdf editor to fill in the forms, but a physical signature may be required upon submission. Forms may be returned to me via fax 503-987-3022, portal message or in person.
New Patients – Please complete the following forms
- New Patient Health History – required for all new patients at or prior to initial visit
- Office and Financial Policies, General Consent Form – required for all patients
- Health Insurance Verification Form – optional, but recommended
- COVID-19 Advisory and Acknowledgement – required to be completed within 24 hours of every in person visit
Telemedicine Visit – if your visit is by telemedicine, complete New Patient forms and this consent form
Acupuncture Patients – if your visit is for acupuncture, complete New Patient forms and this consent form
Transferring From True Health Medicine (THM) – if you are transferring from THM, complete these forms only
Other Forms and Documents – you will be advised if you need to complete any of the following forms
- HIPAA Notice of Privacy Practices – reference document, no signature required
- Release of Records – form to request records from me or have records released to me
- Vitamin D Authorization Form – required prior to Vitamin D testing