Patient Forms

Thank you for making an appointment with A Family Healing Center.

We are Committed to providing excellent care, in a compassionate and caring environment. Our mission is to achieve optimal health for the individuals and the community we serve. Our success is measured by your satisfaction.

For your convenience, and to minimize waiting time in our office we have online forms for you to complete prior to your visit. Please take a few minutes to fill these out before your first appointment.

Please arrive at least 20 minutes early to your first appointment to allow us time to process your information.

Cancellation policy: We have a strict 24 hour cancellation policy. Please call our office outside of 24 hours of your scheduled appointment to avoid a cancellation fee. If you no show or cancel with less than 24 hours of notice a fee will be assessed.

Prescription refill policy: Our office processes prescription refill requests within 72 hours from receiving them. Please contact your pharmacy a minimum of 1 week before you are completely out of your medication and have your pharmacy fax us a refill request to our fax number 503-857-0622.

As a reminder, please arrive with the following information for your appointment:

• Completed Paperwork
• Insurance Card
• Photo ID
• Copay or Coinsurance
• List of medication or supplements you are already on

During your visit, please feel free to ask any questions or share any concerns you may have. Your healthcare is a partnership, and we are counting on you to take an active role. This includes freely discussing symptoms as well as leading a healthy lifestyle. We look forward to meeting you and being a partner in your healthcare. If you have any questions, do not hesitate to contact our office.

Sincerely,

Dr. Jason Black
Dr. Jessie Black

Downloadable copies of any of the above forms can be found at the links below.

Medical Records Release Form

A Family Healing Center Privacy Policy

HIPAA Policy