Intake Forms

Not many people get a thrill from paperwork, but it is necessary. There are a few options.

Option 1: Book appointment and complete forms through client portal. This is recommended and is by far the most simple, user-friendly choice. Feel free to browse the forms to get an idea of what the client portal will have you sign.

Option 2: Download, complete the forms, and e-mail to Gabby@HumlieMedicalNutritionCare.com

Option 3: Download, print the forms, complete and mail to: 
      Humlie Medical Nutrition Care
      109 W 8th St.
      Newberg, Oregon 97132

Option 4: E-mail Gabby@HumlieMedicalNutritionCare.com and request a copy mailed to your address. Complete and mail back to the address in option 2. 

Option 5: (Not recommended) Use appointment time to complete forms verbally. This is the default option if forms are not completed. 

Required Signature:

Consent for Services

Required Signature:

Statement of Financial Responsibility

Required Reading: (no signature required)

HIPPA Notice of Privacy Practices

Signature that you read the previous document: 

Receipt of Notice of Privacy Practices