“Please Read ALL the Information BELOW”

Prior to your first visit, there are 4 things you will need to prepare for your visit  ( takes approximately 30 -45 minutes to complete)

  1. Intake forms for you to fill out for yourself or your child.  You can download these at the bottom of this page .  These forms include a number of questions addressing diet, lifestyle, past medical history, and family medical history.  They also include consent and release forms.  Please take time to fill these out completely.  All the answers are important in understanding you or your child as a whole person and will greatly aid in the evaluation of your health conditions.  Please allow yourself some time to fill out the paperwork before your visit.  The doctor will not start with you unless paperwork is complete.
  2. Bring in any medications, vitamins and supplements being taken.
  3. If you have a copy of recent labs, bring those as well.
  4. Our office policy states that patients are required to verify insurance benefits prior to the office visit. Failure to do so may result in being required to make Full Payment at time of visit.

 

Welcome,

We look forward to meeting you and helping you with your healthcare needs.   Below you will find important information regarding our office policy, directions, and our paper work.  Thank you for taking the time to read this information.  Our intent is to provide you with the highest quality of care.

All paperwork MUST BE COMPLETED prior to your appointment.  We cannot see patients who arrive with Non-Completed paperwork.   Please, arrive 15 minutes prior to your appointment to check in and be ready to start your visit with Dr. Raffety at the scheduled time.

Your appointment time is intended for face to face time with the doctor.  Please reschedule your appointment if you have not completed your paperwork prior to your appointment.  You will be charged for your appointment time if you have to reschedule due to paperwork not being completed.

Due to the high demand for Dr. Raffety time, we need to ensure that only those patients with a sincere intention to keep their appointments are scheduled. Consequently you will be required to make a $ 50.00 deposit by credit card at the time you schedule your appointment.  This deposit will be applied to your charges at the time of your appointment.  This deposit will be forfeit ONLY if you fail to show up on time with completed paperwork, or if you cancel/reschedule without at least 24 hours notice, not including weekends or holidays.

Warmest Regards,

Tigard Holistic Health Clinic and Restorative Health Clinic Staff

 

POLICIES, DIRECTIONS, MEDICAL RECORDS & FORMS

SCENT POLICY:

Many individuals visiting our office are extremely sensitive to odors, chemicals and other products. Because of this, we ask that you please refrain from wearing any cologne, perfume, aftershave, or any other scented products (i.e.: fabric softener/bounce) when you come to our clinic. If you are a person that has environmental sensitivities, we have rooms that are free of particleboard, formaldehyde and other off gassing articles and that are fit with a high quality HEPA air filtering system.

DIRECTIONS TO THE CLINIC:

 

 

How to obtain Medical Records:

Patient’s requesting copies of their medical chart records please fill out an (click on link to print) Authorization to Release Medical Records. Mail or Fax this to our office. Our office policy is we must have an authorization on file to release records.  If you are a patient asking for your own records we will provide a one time courtesy at no charge there after please expect a $25 copy fee.  Our office receives many records request please allow up to 30 days for processing.  Thank you

 

Printable Forms Below:

New Patient Form (click on link to print): NEW PATIENT INTAKE FORM    (For Adults)

Pediatric Intake Form (click on link to print): PEDIATRIC INTAKE FORM (For ages 12 and younger)

Financial Consent/Insurance Status  (All patients need to fill this out regardless of insurance use- click on link to print)

                                                                         FINANCIAL CONSENT/INSURANCE STATUS 

Insurance Verification Form    (Must be filled out ONLY if you are intending to use insurance)

                                                                          INSURANCE VERIFICATION 2013

Lyme Patient Screening Form (click on link to print): Lyme Screen Form Fill out if you are being seen for possible or chronic Lyme Disease.