Skip to main content

Prospective Patients

Patient Forms & Resources

Patient Forms & Resources

Adobe Acrobat is required to view and print these forms. You may get a free copy from Adobe. If you have any questions, please don't hesitate to call 541.488.3133. We're here to help!

Becoming a Patient

  • PLEASE NOTE: The Patient Intake form is a fillable PDF document. Please save the document to your computer BEFORE filling in the blank form and open the document in Adobe Reader or Acrobat. If you open the document directly from your internet browser's previewer and fill in the form boxes, your information will NOT be saved.

  • This 1-page guide offers helpful information on how to become a patient and schedule an appointment.

  • Most of our clients pay for consultation services with our practitioners out-of-pocket. Please see our Rate Schedule for appointments with Dr. Susan Saccomanno or Dr. Pamela Plank for more information.

  • We are able to bill insurance for appointments with patients of Dr. Susan Saccomanno and Dr. Pamela Plank who are Oregon residents, have on-site consultations, and whose insurance covers our services. Please see our Rate Schedule (insurance) for more information.

  • To determine health insurance eligibility with your carrier please see our Determining Health Insurance Eligibility Worksheet.

Additional Resources for New Patients

In-Depth Information About Mederi Care

© 2020 Mederi Foundation

Powered by Firespring

The information on this website has not been evaluated by the FDA, nor does it constitute medical advice. We do not aim to treat, cure, or prevent any illness or disease. We recommend consulting with a qualified health care professional if you have a medical condition, are taking medications, or if you are pregnant or nursing.