New Patient Intake Forms

Preparing for your first visit

Before coming into Pearl Natural Health for your naturopathic, acupuncture or Chinese medicine treatment, there are intake forms for you to fill in. These forms are the first step in helping us get to know what your concerns and expectations are for care.

For adults, please download and bring the below intake forms with you to your first appointment:

Adult Intake Form and Health Questionnaire
Consent to Treatment Form
Policies and Procedures Form
Health Information Consent

Frequently Asked Questions About Your Care

FOR B12 INJECTIONS, PLEASE FILL OUT ALL PAPERWORK BELOW:

B12 Injections: Consent to Treatment

B12 Intake Form

Office Policies and Procedures Form

Health Information Consent

 

For Children please see below:

If your child is young please fill in the pediatric intake form below and sign the consent form, policies and procedures and health information consent as well:

Pediatric Intake Form and Health Questionnaire

Consent to Treatment Form
Office Policies and Procedures Form
Health Information Consent

 

Put yourself on the road to a healthier life and re-claim the vitality you deserve

Contact

Pearl Natural Health
511 SW 10th Avenue, Suite 801
Portland, Oregon 97205
Phone: (503) 230-8973
Fax: (503) 230-8978

Pearl's Ellen Goldsmith's
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