Intake Forms (required for first visit)

Please click on the links below so you can print the forms and bring them with you filled out already.  If you don’t bring them with you filled out, you can always fill them out at the office, but your practitioner would need to know in advance to schedule enough time.   Your treatment time will not be effected.

PRE-AUTHORIZATION is REQUIRED to bill ALL insurance.  Please contact us ahead of time to review your benefits.  We don’t want you to have any unpleasant financial surprises.

If we are billing your HEALTH insurance, please complete these forms: Health Insurance Intake – 5 pages

If we are billing your AUTO or WORKMAN’S COMPENSATION insurance, please complete these forms:  Auto or W/C Insurance Intake – 5 pages

If you have a gift certificate or are paying yourself,  please complete these forms:  General Intake Forms

For your edification or records, here is our Privacy Policy.  DO NOT bring this in for us:  Notice of Privacy Policy

If you’d like us to VERIFY your insurance benefits, please fill out the form below.   ALL information is kept strictly confidential, and NEVER given or sold to anyone.  If you have specific questions, please feel free to contact us anytime – info at BodyBalancePortland dot com or 503-345-7660.

If you’d like us to verify your insurance coverage, please fill out this form:
Verify insurance coverage here