503/891-9654
503/891-9654
1939 NE Broadway St. Suite B
Portland OR 97232
by appointment only
site created and designed by ariana orton • copyright 2012 - oregon clinical massage
This website is for information only and is not meant to diagnose or treat any condition.
Please consult your physician for treatment options for your condition.
If you have been injured in an auto accident,
or if you have a workers compensation claim,
you will need a prescription from your doctor in order for your insurance company to cover treatment.
This form contains all of the information the insurance companies usually require on a prescription.
You can print this form and
take it to your doctor
if you wish.
If you would like to have your paperwork filled out ahead of time,
the forms we use are available here in PDF format.
If you are a new patient and you are not coming in with a prescription, this is the form for you.
If you have
been injured in
an automobile collision, you can fill in this form and bring it with you to your first visit.
Established patients complete this form
at each repeat visit.
forms
If you are seeking
treatment on a workers
compensation claim,
you can fill in this form and
bring it with you to your first visit.