Natural Family Medicine | 360-882-1339 | 16701 SE McGillivray Blvd, Suite 265, Vancouver, WA 98683 |

Call 360-882-1339 to schedule an appointment!

Forms

ALL Patients and visitors: Please be aware that we try and maintain a healthy environment for all. Please do NOT wear any fragrances or perfumes into our office. This includes clothing that may have been washed in scented detergents as well as personal care products such as soaps, shampoos, hair sprays, after-shave products, lotions, etc. These products tend to be potent endocrine disruptors as well as general toxins. You may be asked to re-schedule your appointment if you arrive “scented”. Thank you for your understanding and support of health!

 

NEW PATIENTS:  Please download these four “New Patient” .pdf files, fill them in completely, and bring them to your first appointment.

PLEASE note that Dr. Brown needs to have your completed forms at least 15 minutes prior to your appointment time or you may be asked to reschedule.

New Patient Letter

Patient Information Form

New Patient Health History Form

New Patient Protected Health Information Form

 

 

ADDITIONAL FORMS:  Please complete these forms only as prescribed by Dr. Brown.

NT AF for Adults

MAF for Adults

CNNQ Form for Children

Release of Records

Brain Function Assessment Form

Brain Health and Nutrition Assessment Form