If you have questions about filling out these forms please call the office at (503) 452-8002 or email

The forms below are offered in a fillable PDF format, they require you have Adobe Acrobat Reader to download, display and print properly.  Please download the form first, complete and email it to our secure address: or submit to our fax number, (503) 452-0084.

If you email images, rather than PDF attachments of your paperwork, you must also mail the actual forms to us or drop them off at the clinic (slide them under the door).

Forms should be submitted several days before the appointment so your clinician has time to review the information.

Release to Disclose Confidential InformationFillable PDF
Consent for Telehealth ServicesOnline Form
Consent for Use of a Language InterpreterFillable PDF
Consent for Use of a Language Interpreter - EspañolFillable PDF
Stored Pay Card SetupOnline Form