Serving Eugene-Springfield and surrounding areas

Forms

First Appointment Intake Form:
Please print, fill out, and bring to your first appointment.

Oregon Naturopathic Clinic Intake Form   

Special Forms:

Environmental Toxic Exposure and Chemical Sensitivity Questionnaire Part 1  – Intended only for patients who have significant concerns about toxin exposure, detoxification, and chemical sensitivity.

Environmental Toxic Exposure and Chemical Sensitivity Questionnaire Part 2   – Intended only for patients who have significant concerns about toxin exposure, detoxification, and chemical sensitivity.

Candida Questionnaire  – Intended only for patients who have concerns about Candida

Special Handout:

Methyl Genetic Nutrition Assessment and Treatment Starting Guide –  Intended only for patients who are interested in Methyl Genetic Nutrition treatment. This can be preformed before or after you first appointment.

Policies

HIPAA Notice of Privacy Practices   – You do not have to print out this form, unless you want it for your records.

Email and Cell Phone Text Communication Policy   – You do not have to print out this form, unless you want it for your records.

Map Directions

Map to Oregon Naturopathic Clinic

We are on the second floor with no elevator access. If you are not able to climb stairs or need disability accommodations please let us know before your appointment so we can make arrangements for you.

IMPORTANT Instructions For First Appointment

If possible, please bring all supplements, medications and any pertinent imaging/lab work, insurance card (if we are billing insurance for you) to your first visit. This will help doctor Kim in providing you the best care possible.

Schedule your visit today! Schedule Appointment