Health Roots Natural Medicine
Dr. Mindy Cash and Dr. Ann Holland
Holistic Primary Care Medicine

* Please complete and print these forms before your first visit to our office (blue or black ink only please).


*Intake Form
*Privacy Practices
*Financial Information
*Consent Form
*Pt. Intake

Records Request (if you would like us to review your prior medical records, please complete this additional form and send it to your physician).




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Health Roots Natural Medicine | 4625 SE Center St. Portland, OR 97206 |
Phone 503.772.1700 | Fax 503.788.5894 | email: info@healthrootsnaturalmedicine.com