Patient Forms

empowering

      A MORE ABUNDANT

                           life

PLEASE NOTE: All of our forms are available as fillable PDF forms.  To access, view, download, complete and print fillable forms you will need to use Adobe Acrobat Reader.  Adobe Acrobat Reader is available for free and can be downloaded from the following web site: https://get.adobe.com/reader/.

There are three methods you can use to complete the forms and ensured they are filled out:

     Method

     1.  Right click on the form you need and select "Save link as" and then give the file a name.  This will save a blank copy

          of the form in one of your folders.

     2.  Then go to your folder and open the file in Adobe Acrobat Reader.

     3.  Type/ fill in all grey boxes.  All boxed outlines in red are required.

     4.  Save your file.

     5.  Please email your completed forms to info@sundstromclinic.com.  Use “New Client Registration” as the subject

           line and make sure to attach your forms.

     Method 2

     1.  Click on the form you need.

     2.  Once the form appears, download the forms and give it a name and save it in a folder.

     3.  Then go to your folder and open the file in Adobe Acrobat Reader.

     4.  Type/ fill in all grey boxes.  All boxed outlines in red are required.

     5.  Save your forms and give your file a name.

     6.  Please email your completed forms to info@sundstromclinic.com.  Use “New Client Registration” as the subject

           line and make sure to attach your forms.

     Method 3

     If you do not have access to filling in PDF forms you may also print the blank forms, hand write in your answers, and

     mail them to:

                             Sundstrom Clinical Services

                             21900 Willamette Drive, Suite 202

                             West Linn, OR 97068

New Client Registration:  If you are a new client, please complete one of the following sets of registration forms below.  Please note that all of our forms are available as fillable PDF forms.  Directions are included in each packet on how to complete the forms.  

          Child & Adolescent Registration Forms (0-17)

          Adult Registration Forms (18+)

          CPNP Registration Forms

          Nutrition Intake Packet (Current Client)

          Nutrition Intake Packet (New Client)

Miscellaneous Forms (if needed):

          Release of Information (ROI)

          Cancellation and No Show Appeal

          Telehealth Consent Form

If needed you may also view and complete individual forms here:

           Informed Consent

           Client Registration

           Financial Agreement

           HIPAA Privacy Notice (Read Only) 

           HIPAA Acknowledgement and Consent 

           Cancellation and No Show Agreement

           Child & Adolescent History Form (0-17)

           Confidential Adult History Form (18+) 
           CPNP History Form

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

(p) 503-653-0631    (f) 503-653-1464 

www.sundstromclinic.com