mindful medicine, inspired health
New Patient Forms
Please fill out each of the forms from the first link completely and fax them, mail them, or bring them with you to your first appointment. The Release Of Information Request is to allow a former healthcare provider to release records to Dr. Ott, and will need to be filled out with the fax number of your former provider if you wish them to be requested. You may also request your records directly from your previous provider, though not all records are necessary if one has been relatively well. The signature page is especially important as it allows your insurance company to pay Nanopractice PDX directly for your claim, and indicates that you have read and agree to abide by the practice policies as set forth under the practice policies tab. The last item (Notice of Privacy Practices) is provided electronically and is available by request in paper form.
Thank You!