Forms and Documents

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. New patients, your required forms will be sent to you upon scheduling. Established patients, if you need a form, please message me through the portal or call/text me at 503-987-3622 to have a form sent to you electronically.

For patient transferring from True Health Medicine

If your last visit occurred prior to today’s date in 2018, you are considered a new patient. Please schedule a new patient visit and your forms will be sent to you directly.

Office and Financial Policies, General Consent Form

Acupuncture Consent Form

Demographics and Insurance Update

New patient forms

Please note that these forms will be sent to you as an electronic questionnaire after you schedule an appointment. Most patients find this a convenient way to complete their paperwork and I prefer to receive paperwork that way. If you are unable to complete your paperwork electronically, feel free to print out the following forms and complete them prior to your initial visit.

New Patient Health History

Office and Financial Policies, General Consent Form

Acupuncture Consent Form

HIPAA Notice of Privacy Practices

Health Insurance Verification Form (optional)

Other Forms

COVID-19 Advisory and Acknowledgement

Release of Records

Telemedicine Consent Form

Vitamin D Authorization Form