New Patient Application

*PCNH is no longer accepting Medicaid & Medicare of any kind.
**Dr. Amber is now accepting new patients of both Oregon & California.

Review Our Rates/Insurance & Fees Review Our New Patient Process

"*" indicates required fields

New Patient Application - Step 1

First Name*

Last Name*

Nickname/Preferred Name

Date of Birth*

Phone*

Email*

What are your preferred methods of communication? (Check all that apply)*

Text

Phone Call

Email

Will you be using an insurance plan with benefits/coverage or will you be an out-of-pocket/cash-paying/non-insurance patient?*

Who is your insurance carrier?*

Heads up!

Unfortunately, we do not accept your indicated insurance plan. If you'd like to move forward in becoming our new patient, you will be considered an out-of-pocket patient and pay our cash rates. Payment Plans are available for those who need them!

I understand that I will be an out-of-pocket patient and that PCNH does not accept my insurance*

I understand

Do you have a preference on practitioner?*

How did you hear about the Portland Clinic of Natural Health?*

New Patient Application

New Patient Application - Step 1

Heads up!

Patients w/ Insurance: Accepted Insurance Plans

Patients w/o Insurance

For All Patients

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