Patient Forms and Policies

Welcome! You will find our forms below – please bring them to your visit.


We look forward to working with you.




Please download these forms and turn in signed copies at the first visit:

Milwaukie Adult Intake.RHC – New Patient Form

Milwaukie Child Intake

Milwaukie Consent-Dr. Ali Givens

Patient Consent Form.HIPPA



For all follow up visits, please download, fill out and bring in the following form:

PATIENT INTAKE FORM – Follow Up




Policies: please read before your first visit

Right to Confidential Communication Policy

Notice of Privacy Policy.HIPPA


For more information, see FAQ , or contact us at (503) 303-4078.