forms

Feel free to prepare for you visit by reading the information below and completing your new patient paperwork.

Feel free to prepare for you visit by reading the information below and completing your new patient paperwork.

As a courtesy, automatic e-mail or text reminders will be sent out in advance of your scheduled appointment, if you elected to have them set up for your account. Asula cannot guarantee the accuracy of the delivery of appointment reminders. You are ultimately responsible for keeping track of scheduled appointments.

A 24-hour cancellation notice is required for all scheduled appointments.  Rescheduled, missed or no show appointments without 24 hours notice will result in your being charged a $40 late cancellation fee unless the appointment can be filled.  We have this policy so that we can best accommodate our patients and practitioners.

Before your first visit, please complete the new patient forms for the service(s) you will be seen for.  These forms can be completed online, and either emailed back to our front desk staff, or print and bring them to your first appointment. Please email completed forms to office@asula.com (Pearl location) or lakeoswego@asula.com (Lake Oswego location). 

If you are unable to complete these forms before your appointment, please arrive 15 minutes before your scheduled appointment time to complete them in our office.

Please bring your insurance card (if applicable) to your first appointment so we can scan a copy of it into your medical record.

Chiropractic Patient Forms
Chiropractic Intake
Consent and Signature Form
Benefits Processing Disclosure

     

Treatment of Minors Form
If the patient is a minor, please complete
this form in addition to the other new
patient forms to the left:
Consent to Treat a Minor

     

Acupuncture Patient Forms
Acupuncture Intake
Consent and Signature Form
Benefits Processing Disclosure

  Motor Vehicle Accident / Personal Injury
If your appointment is due to a motor vehicle
accident or personal injury, please complete
these forms in addition to the other new
patient forms to the left:
MVA/PI Additional Intake
Doctor's Lien
     

Naturopathic Patient Forms
(Pearl location)
Naturopathic Intake
Consent and Signature Form
Benefits Processing Disclosure

  Medicare
If you are a Medicare aged patient, please 
complete this form in addition to the other
new patient forms to the left:
Medicare Billing Disclosure
     
Naturopathic Patient Forms
(Lake Oswego location)
Naturopathic Intake (Lake Oswego)
Policies and Signature Form
Benefits Processing Disclosure
   
     
Pedicatric Naturopathic Patient Forms
(Lake Oswego location only)
Pediatric Naturopathic Intake
Consent and Signature Form
Benefits Processing Disclosure
   
     
Ayurveda Patient Forms
Ayurveda Intake
Consent and Signature Form
Benefits Processing Disclosure
 

 

     
Massage New Patient Forms
Massage Intake
Consent and Signature Form
Benefits Processing Disclosure