* IMPORTANT – please complete this form before you come for your appointment.
Please print out and fax or email to my billing company Pacific NW Billing prior to first session,
Toll Free 888-894-0646
Toll Free 888-893-5831
PNWB will send you a copy of your insurance verification if you would like (please be aware this coverage is an estimate only and not guaranteed)
Complete the Intake form and review and sign the HIPAA Notice of Privacy Practices and Office Policies and General Information documents. The Professional Disclosure Statement is for you to keep.
Bring the 6 completed and/or signed forms to your first appointment. If you have any questions, please do not hesitate to call 503-740-5742 for more information.