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 significant 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 your first appointment.

Policies

HIPAA Notice of Privacy Practices  

Email and Cell Phone Text Communication Policy   

Prescription Medication Policy  

Map Directions

Map to Oregon Naturopathic Clinic

IMPORTANT Instructions For Your First Appointment

The main clinic is on the second floor with no elevator access.  If you are not able to climb stairs please let us know before your appointment so we can set up the alternative access treatment room on the first floor.  You must bring a filled out intake form to your first appointment or show up 15 minutes early and fill out an intake form in the waiting room.  Your first appointment cannot start until this form is filled out and your appointment may be shortened if it is not completed by the scheduled start time of your appointment.  If possible, please bring all supplements, medications, 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