Patient Forms

empowering

      A MORE ABUNDANT

                           life

If you are a new client, please complete the following forms by clicking on forms listed below:

 

     Client Registration

     Financial Agreement

     HIPAA Privacy Notice (Read Only) 

     HIPAA Acknowledgement and Consent 

     Cancellation and No Show Agreement

     Confidential History Intake Forms (please select either the Adult, Child, or CPNP form):
                        Adult Intake (18+) 
                        Child/Adolescent Intake (0-17) 
                        CPNP Intake (Medication Management 0-21 years old) 

                        Nutritional Intake

Other Forms:

     Release of Information (ROI)  (0nly if needed)

     Cancellation and No Show Appeal

 


NOTE: Our system currently does not allow auto-fill.  Please print forms in order to complete them.  Please contact our office to schedule an intake appointment.  Forms need to be returned to our office prior to your initial appointment. 

Please be sure that each form is completely filled out.  In order for your provider to maximize your time with them at your first appointment, it is very important that you complete the History Intake form as thoroughly as possible.  To return your paperwork you may deliver it in person, mail, email, or fax to:

Sundstrom Clinical Services
21900 Willamette Drive, Suite 202
West Linn, OR   97068

Fax: 503.653.1464

 

If you choose to send your paperwork via email, please include "New Client Documents" in the subject line.  PLEASE BE ADVISED THAT DOCUMENTS RETURNED VIA EMAIL ARE NOT SECURE.  If you have any questions regarding paperwork please call our office at 503.653.0631.  Office hours are Monday-Thursday from 9:00-5:00 and Friday from 9:00-3:00.  Thank you.

21900 Willamette Dr., Suite 202      West Linn, OR   97068

(p) 503-653-0631    (f) 503-653-1464 

www.sundstromclinic.com