Patient Forms

Please download and complete the appropriate form(s) below, under your provider’s name, and bring to your first appointment.

Acupuncture Providers: Dawn-Starr Crowther, L.Ac.; Amara Narten, L.Ac.;  Betsy Gordon, L.Ac.

We ARE in-network with most major insurances, such as Cigna, UHC, Regence BCBS and other BCBS, Providence, CHP, Kaiser, etc. for Acupuncture.

However, WE DO NOT ACCEPT AETNA OR HEALTH NET insurances for acupuncture.
WE ARE GOING OUT OF NETWORK WITH CIGNA effective 1-1-2018.
Please call our office to verify insurance plan participation at 503-297-3825.

Acupuncture New Patient Health History

  Chikako Harper, N.D., L.M.T.

Dr Chikako Harper New Patient Intake Form English
Dr Chikako Harper New Patient Intake Form Japanese

Submit insurance information by completing this form:  Please click on this link to be directed to the company that provides insurance billing for Dr. Chikako.  This helps process insurance claims efficiently and accurately.   Please do this before your first visit.

Petra Caruso, N.D.

Dr. Petra Caruso New Patient Intake Form

Yarley Nystrom, L.M.T.

Yarley Nystrom LMT HIPAA Form
Yarley Nystrom LMT New Client Intake Form

Michele Wren, L.M.T.

Jenny Chapleau, L.M.T.