Forms

WATCH THIS VIDEO ON HOW TO FILL OUT NEW PATIENT PAPERWORK

Please use this link for New MHW Patient Info and Registration Paperwork.

If this link is temporarily unavailable then please use this paper copy version:
Paper Version of New Patient Paperwork.

If we need past medical information from your previous medical providers, please fill out the Release of Medical Information Form HERE and bring it to the first office visit.

A copy of the MHW privacy and policy statements can be found here.
Refund/Return and Delivery Methods can be found here.

**We may decline to renew any controlled substances at your first appointment as that is our clinic policy.**

If you are in need of controlled substances and we agree to prescribe to you, you will be asked to review and sign this form. MHW Controlled Substance Agreement.

ALL OHP/HealthShare/CareOregon patients requiring chronic pain medication will be enrolled into the Quest Integrative WISH Program.

All of our providers like to limit the use of opioid pain medication and benzodiazepines due to the overwhelmingly negative side effects of long term use.

Benzodiazepines may increase the chance of dementia/alzheimer’s.

Opioid Addiction Statistics

IUD Consent Form

IUD Consent
Implantable Contraceptive CIIC

Advance Directive, POLST, End of Life Planning

About POLST and Advance Directives
Advance Directive Form
Five Wishes sample

Useful Patient Symptom Forms – Institute For Functional Medicine

MHW Hormone Questionnaire
MHW Digestive (gut) Wellness Questionnaire
Toxicity Questionnaire
Short-Inflammatory-Bowel-Disease-IBD-Questionnaire_BRFINAL_v2

Toxin-Exposure-Questionnaire_BRFINAL_v2
Thyroid-Screening-Questionnaire_BRFINAL_v2
HPA-Axis-Questionnaire_BRFINAL
Candida-Screening-Questionnaire_BRFINAL_v2
Functional-Medicine-All Body Symptom Questionnaire

Useful Patient Dietary Info

MHW Phased Diet
Diet Guide MHW
MHW Food List
MHW Vegetables
Anti-Candida-Food-Plan_BRFINAL

Useful Patient Info

Multnomah County Syringe Disposal Information