Blue Lily
Patient Forms
Save time, and make sure you have the right information at hand.
Just print and fill out the Health History and Patient Intake forms
before coming in for your first office visit. And feel free to read the
Notice of Privacy Practices for your information.

> Health History
> Patient Intake

We look forward to seeing you! If you have any questions, feel free
to
contact us.
Common Ground Wellness
Center
5010 NE 33rd Ave
Portland, OR 97215
phone: 503-
238-1065
bluelilydoctor@yahoo.com