New Patient Forms

Intake Questionnaire

PLEASE NOTE that the above file has an old business address. I am currently unable to upload new versions of files to this website due to aging digital infrastructure. The current business address is 320 E 47th Ave, Eugene, OR 97405.

Click the link above to download the new patient forms. These forms are designed to be printed from Adobe Acrobat. If you don’t have Adobe Acrobat, a free version of Acrobat Reader is available here.

Please print these out, complete the questionnaire, read, sign and date the Insurance Agreement form (if appropriate), and the Notice of Privacy Practices and Informed Consent form, which includes a description of therapeutic modalities. Please bring these completed forms to your first office visit.

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