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.