Forms

Prior to your visit, you will need to log into the patient portal and complete the intake form, our clinic policies, consents and the insurance verification form.


Once you schedule, you will receive a call from our office manager to collect some information from you so we can sign you up for the patient portal. In the patient portal you will receive a link to the intake form, our clinic policies, consents and the insurance verification form that needs to be filled out a minimum of a day prior to your appointment.
If for some reason you are unable to sign into the portal, you can download the forms in the following sections:

 

Insurance Verification Form
The insurance verification form (which you may download here) is the form you will you use to make sure you collect needed information when you call your provider to verify your insurance coverage (e.g. providers and services that are covered in and out of network, deductibles, number of visit limitations, etc.).    Please bring this completed form to your first appointment.

Self Pay Consent
If you do not have insurance or decide not to use your insurance, we need you to review our self payment form. This form was created in compliance with the law to avoid surprises for patients not using their insurance. We have a list of possible fees you may owe for services rendered at Amber Wellness Group. Please review and sign the No Surprise Form  and bring it to your appointment. If you have any questions, please reach out to the clinic at 971-319-0045.

Patient Intake Form
The patient intake form (which you may download here) helps you to provide us with contact information as well as your current and historical general health and wellness.  It gives us a broad overview and a starting point for getting to know you and your health care needs.   Please bring this completed form to your first appointment.

Release of Records Form
If you have any lab or imaging records from the previous year from another provider, please fill out the Release of Record Form . You can either submit to the outside provider yourself or email the completed form to us and we will coordinate for you.

Consent Forms
When you schedule, the following consent forms will be sent to you via email. If you would like to download and read the Clinic policies and HIPAA Privacy Practices, you can do via the link below. If you are seeing a provider via telemedicine, please make sure you have read and signed the signature form before your appointment. This will confirm that you have read, reviewed and understand all notices of our policies and practices.