forms

Feel free to prepare for your visit by reading the information below and completing your new patient paperwork.

We are still required by the federal government to wear face masks or coverings at our office since we are a medical facility. We will be unable to complete your appointment if you prefer to not wear a face covering or mask to your appointment.

We have welcomed patients back into the office to wait for their appointments. Please come into the office to check-in and you can either wait inside or outside, depending on your preference.

As a courtesy, automatic e-mail or text reminders will be sent out in advance of your scheduled appointment. Asula cannot guarantee the accuracy of the delivery of appointment reminders. You are ultimately responsible for keeping track of scheduled appointments.

A 24-hour cancellation notice is required for all scheduled appointments. Rescheduled, missed, or no-show appointments without 24 hours notice will result in your being charged a $40 late cancellation fee unless the appointment can be filled. We have this policy so that we can best accommodate our patients and practitioners. If you are sick, we prefer you to stay at home, so please contact us so we can reschedule your appointment (you will not be charged a late cancellation fee if you are sick).

Before your first visit, please complete the new patient forms for the service(s) you will be seen for and email them back to us ahead of your appointment. These forms are fillable PDF’s, so they need to be downloaded to your device, saved to your device, filled out, and then email completed forms to [email protected] (Pearl location) or [email protected] (Lake Oswego location).

If you are unable to complete these forms before your appointment, please arrive 15 minutes before your scheduled appointment time to complete them in our office.

Please take a photo of the front and back of your insurance card (if applicable) and email it to the office ahead of your appointment.

Treatment of Minors Form
If the patient is a minor, please complete this form in addition to the other new patient forms to the left:
Consent to Treat a Minor

Motor Vehicle Accident / Personal Injury
If your appointment is due to a motor vehicle accident or personal injury, please complete these forms in addition to the other new patient forms to the left:
MVA/PI Additional Intake
Doctor’s Lien

Medicare
If you are a Medicare aged patient, please complete these forms in addition to the other new patient forms to the left:
Medicare Billing Disclosure
Medicare ABN (Advance Beneficiary Notice of Noncoverage)

Guides for Checking Benefits & Limits
If you would like to use a guided form to check your benefits or annual limits, please utilize the forms below:
How to Check Your Annual Limits
How to Check Your Chiropractic Benefit
How to Check Your Acupuncture Benefit
How to Check Your Naturopath Benefit

Portland
818 NW Marshall St
Portland, OR 97209
503-719-5335

Lake Oswego
4847 Meadows Road
Suite 153
Lake Oswego, OR 97035
971-330-8578