Intake Forms

Dr. Andrew Kim - Naturopathic Physician - Chinese Medicine

The Healing Arts Clinic - an association of independent practitioners

3644 SW Troy Street, Portland OR 97219    phone: 503-244-7331    fax: 503-977-0502

 

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

 

You may need Adobe Acrobat to view and print these forms.  The latest version can be downloaded for free here.