Intake Forms

Dr. Andrew Kim

Naturopathic Physician - Acupuncturist

Practitioner of Chinese Herbal Medicine

GroundSpring Healing Center

8283 SW Barbur Blvd, Portland OR 97219    phone: 503-244-7331    fax: 503-662-6344

Please download the appropriate Intake Form and bring it with you, completed, to your visit. 
If you do not have access to a printer, please call our office and we will be happy to mail you a copy. 

 

Adult Intake

 

Pediatric Intake, Ages 0 to 5 Years

 

Pediatric Intake, Ages 6 to 12 Years

 

Physician Referral Intake
For patients referred by their primary care physicians for Food Sensitivity Testing only

 

Release of Records

 

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