Psychiatric Medicine & Psychotherapy Patients
New Patient Checklist:
Insurance card
New Patient Intake Forms (See below)
List of medications or actual bottles
ROI for anyone with whom you would like us to coordinate care
Credit Card Authorization Form (Please return via USPS, secured email, or fax it to the practice at to (503) 713-5395 in order to confirm and hold your appointment time within 72 hours of making the appointment. NOTE: All missed appointments or appointments cancelled with less than 48 hours notice, will result in a $250 to the patient. Insurance does not cover these fees.)
Insurance: If you are using insurance please check with your insurance company about your coverage. Ultimately patients are responsible for all fees for services provided to them.
Insurance/Billing
Please click on the link to learn more about Portland Family Wellness billing policies and insurance coverage.
New Patient Intake Forms:
If you are unable to download or print these forms please contact us and we will have them waiting for you at the office. You will then need to arrive 20 minutes early to complete the paperwork.
Please download the appropriate patient packet, fill it out and bring it with you to your first appointment.
Please print out an ROI for each person with whom it would be helpful for us to coordinate care, such as a Therapist, Teacher or Primary Care Physician.
Please review the Privacy/HIPAA statement and the Professional Disclosure statement. They do not need to be printed but should be reviewed. In the packet you will be asked to sign a statement reflecting that you have reviewed these forms.
Five things to know before your first appointment
1. Forms
You can download the forms you need to complete before your first visit. Bring the completed forms to your first appointment. If you cannot download and print the forms, you will need to contact our office at 503-679-6470 and let us know to leave the forms out for you to complete. Please arrive half an hour early to your appointment to complete them prior to our meeting
2. Medications
Please bring a list of all your current medications (including over the counter medications and herbal medications) with you to your first appointment. Some patients find it easiest just to bring their medications to the first appointment.
3. Contact Information
Please bring contact information for your primary care provider and your therapist. On this page you will find forms called "release of information" - please complete one for each provider so that we can communicate with your other care providers in assisting providing you with optimal care.
4. Payment/Insurance
Please bring your insurance card with you to the first appointment. Prior to our first appointment we recommend that you contact your insurance company directly and ask them these billing questions; this way you know prior to our first meeting what your financial responsibilities will be. If we are out-of-network for you, payment in full for services will be collected from you at the time of service. We can bill your insurance as a courtesy or provide you with a receipt to submit for reimbursement directly from your insurance provider. If are in-network, co-pays and deductibles will be collected from you at the time of service.
5. Policies
Please review our policies before your first visit and review the billing questions. It is our policy that if you need to cancel an appointment that you call us with 48-hour notice so that we have the opportunity to offer the appointment time to another patient. If you do not attend a scheduled appointment or cancel an appointment with less than 48-hours notice, you are responsible for the entire charge for that visit (not the co-pay) as insurance companies do not reimburse for missed appointments. We share office space with other independent practitioners. We are only at the office for scheduled appointments. If you need to contact us, please call 503-679-6470.