Intake Forms

Patient Intake Forms

Online Form

For your convenience, Therapydia offers two ways to complete your intake forms. To complete the online form, please select the clinic location below.

Oregon

Select the following link to be be redirected to the online form.

Therapydia Beaverton – View Form

Therapydia Gresham – View Form

Therapydia Happy Valley – View Form

Therapydia Lake Oswego – View Form

Therapydia North Portland – View Form

Therapydia Portland – View Form

Therapydia SE Portland – View Form

Therapydia Progress Ridge – View Form

Therapydia Tanasbourne – View Form

Washington

Select the following link to be be redirected to the online form.

Therapydia Ballard – View Form

Therapydia Hazel Dell – View Form

Therapydia Queen Anne – View Form

Therapydia Vancouver – View Form

Printable Form

If you prefer to print the forms, complete them by hand, and either email or bring them to the clinic, please download the PDF file.

PDF Download

Pelvic Health Intake Form

If you have schedule a Pelvic Health Evaluation, please complete the Pelvic Health Intake Form.

PDF Download

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Portland
2808 E Burnside St.
Portland, OR 97214
Phone: (503) 477-4802
North Portland:
4140 N. Williams Avenue
Portland, OR 97217
Phone: (971) 347-1774
Lake Oswego
4859 Meadows Rd. #161
Lake Oswego, OR 97035
Phone: (503) 387-6081
Beaverton
3925 SW 153rd Dr #210
Beaverton, OR 97003
Phone: (971) 727-8155
SE Portland:
3838 SE Powell Blvd
Portland, OR 97202
Phone: (503) 603-4555
Gresham
1027 NW Norman Ave.
Gresham, OR 97030
Phone: (971) 362-3288

Progress Ridge
15000 SW Barrows Road
Suite 201, Beaverton, OR 97007
Phone: (971) 930-4433
Tanasbourne:
9282 NE Windsor St
Hillsboro, OR 97006
Phone: (503) 606-8849
Vancouver:
1125 SE 163rd Place Suite 102
Vancouver, WA 98683
Phone: (360) 768-4340
Happy Valley:
13120 SE 172nd Ave
Building B, Suite 108
Happy Valley, OR 97086
Phone: (503) 825-2232
Hazel Dell
7604 NE 5th Ave. #109
Vancouver, WA 98665
Phone: (360) 597-7570