12511 SW 68th Ave
Portland, OR 97223

Phone 503-675-1137
Fax 503-534-1137



Downloadable Patient Forms

Changing Doctors can be very stressful. To facilitate a smooth transition, please complete and print out the New Patient Form. Arriving 15 minutes early will allow a comfortable initial check in. Don't forget your insurance card and drivers license.

Our clinic runs on time. This can be an adjustment for new patients as we do not double book appointments. Arriving on time allows us to respect every patient's busy schedule and will become another reason you are glad you found our clinic!

Please note none of our physicians prescribe chronic opioids or benzodiazepines. We will refer to pain management or psychiatric services.



New Patient Paperwork and Form

New Patient Form Package Please print off this document and bring the completed package to your first visit

Flu Shots 2020- 2021

You will need a Flu Vaccine Consent form. You can either print off a blank form or fill online: In both events, please be sure to bring a copy with you.

Then click this link to schedule your visit : Schedule Your Visit

4.  Medication List (Please bring completed form to your annual physical or if it has been more than three years or any major changes to your regime) You DO NOT need this if you are a new patient, this information is already in New Patient Form Package #1
5. Medicare Preventative Services If you are new to Medicare, the Annual Wellness Visit is different than the physical you may be accustomed to. This is the most comprehensive explanation of what to expect we have found.

MVA Information

  • MVA FormYou need to have this information previous to your appointment or at the time of your appointment. If there is missing information, we will collect $160 at the time of the appointment and you will be able to bill auto insurance company.

Worker Comp (established patients only)

We are not treating Worker Comp cases at this time. Please contact your HR department and ask for a referral. We are not billing Worker's Compensation Policies at this time.