Directions for Patient Intake Form – Child
Please download and complete the Parent Checklists before beginning this form. You will be asked to attach the Parent Checklists at the end of your submission.
Please complete the forms to the best of your ability. Mark “n/a” for any information that is not applicable to your child. If you would like to complete the PDF version of our patient agreement and email it to us as an attachment, you can find the form at the bottom of our Intake Process page.
Please contact our office with any questions at 503.575.9402. Thank you!