Caution!

Visiting this web site requires a newer version of Netscape Communicator.

Visit Microsoft's Web site to obtain the newest version of Internet Explorer, or visit Netscape's Web site to obtain the newest version of Netscape Communicator.

Visiting this web site without first upgrading your browser may result in unreliable behavior.












Dr. Chris Booren, Naturopathic Physician



Home Page


Mission Statement
Naturopathic Services Offered

Naturopathic Services


Natural Therapeutics


About Dr. Chris


Optimal Health Center

Communications



Hours of Operation


Specials


Calendar of Events


FAQ/About Naturopathic Medicine


Links To Alternative Practioneers

Specialties



Acupressure
Allergies

Allergies
Birth Doula

Birth Doula


Cancer Treatments


Chronic Conditions


Detox Programs


I.V. Therapy
Pediatrics Naturally

Pediatrics

Forms



New Patient Information


Office Policies


Comfidentiality Agreement


Medical History


Current Health Assessment




  We're Easy to Find! (map)
Naturopathic Medicine


Optimal Health Center
1820 SW Vermont St. Suite G, Portland, OR 97219  
(503) 246-3919   

drchrisbooren@yahoo.com  




New Patient Information

 


Name *
Last, First & Middle Initial
Today's Date: *
Address *
Including: City, State, Zip
Primary Phone *
Secondary Phone
E-mail Address *
Date of Birth *
mm/dd/yyyy
Gender: *
Male   Female  
Social Security Number
Emergency Contact *
Name
Contact Phone Number
Emergency Contact
Employment
Job Title:
Employer:
Company Name
Work Phone:
How did you hear about us? *
Internet, Insurance Company, Referral-please give us their name
Do you have Health Insurance *
Yes   No  
Insurance Company (if applicable)
Please enter name of Agency
Member or Subscriber ID #
please provide copy of insurance card at first visit
Signature
Sign at first office visit.

* Required to submit this form


















Sign In