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  • Home
  • Make Appointment
    • Before Your Appointment with Samantha
    • Before Your Appointment With Dr. Gemma
    • Before Your Appointment with Dr. Eva
    • Before Your Appointment with Dr. Shay
  • About Us
    • About Samantha
    • About Dr. Gemma
    • About Dr. Eva
    • About Dr. Shay
  • Our Disciplines
    • Chinese Medicine
    • Family Medicine
      • About Holistic Family Medicine
      • Family Medicine Resources
  • Policies & Forms
  • Contact
    • General Inquiry
    • Contact Billing
  • Clinic Safety Protocols

Elderflower Medicine:

New Patient Intake Paperwork

Records Request Form

Notice of Privacy Practices

Office and Billing Policies

Acupuncture Only:

New Patient Intake Paperwork

New Patient Motor Vehicle Accident Paperwork

New Patient Acupuncture Questionnaire

Arbitration form needs to be printed in color, otherwise wait and sign at your appointment

About arbitration

  • Address:3257 SE Hawthorne Blvd, Suite C, Portland, OR 97214
  • Phone: Clinic503-234-2070
  • Phone: Eva - Acupuncture only503-893-9418

    • Fax: Clinic844-373-1869
    • Fax: Eva - Acupuncture only503-343-6149
    • Email:click here to email us

    [contact-form-7 id=”298″ title=”Contact form”]