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Patient Forms

New Patient Registration
Used by all new patients. You can save time by filling this out in advance.

For Pacificare patients only. (American Specialty Health Networks)
Patients insured by
Pacificare / ASHN will need to fill these 2 forms out. Click on the links to download the forms. then print them out. The images are viewable / printable using the Imaging viewer which comes with Windows.

Pacificare / ASHN Form 1
Pacificare / ASHN Form 2


Snail Mail: Dr. Juniper Martin, Suite A2
11825 SW Greenburg Road
Tigard, OR 97223