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* Dr. Ben & Dr. Amber are no longer accepting new CareOregon patients.
** We do not accept any type of Medicare.

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

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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

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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