Patient Forms


Please bring all of your completed forms in the PDF packet to your first visit.
If you have access to a fax machine, fax your paperwork prior to your appointment to 503-512-5850. This allows the doctor time to study your chart in detail.

If you do not have access to a printer, please call our office at 503-239-1022 and we can mail you the appropriate forms.

Be sure to complete the paperwork specific to your practitioner.
Forms for each practitioner can be found on their provider pages.

Medical Records & Release Form

To have your records sent to your provider(s) at Portland Natural Medicine from another provider or facility, please download and complete our Medical Release Form here. Give the completed form to the provider or facility that will be sending your records. Please note that the sending medical office may have additional requirements for authorizing records to be released.

The practitioners at Portland Natural Medicine keep private, secure medical records regarding your health.
At any time you may:

  • Review the information in your medical records.
  • Request a copy of your medical records.
  • Request that your medical records be released to someone else (examples include a medical facility or a health care provider).

Please contact us if you have any questions.