Patient Resources

Consultation Forms

Below you will find the different forms needed for your appointment at Elixir. Please click on the appropriate form to download and print it. Please complete these and bring them to your appointment. It is recommended you arrive at least 15 minutes early to your initial appointment to read through and sign the office policies and consent forms.
We recommend allowing yourself time to be thorough as you fill out this paperwork, as it will give us a very in-depth look at your health and the areas that we need to spend time understanding and addressing.
Intake Forms:
These can be filled out electronically through your patient portal or in the office prior to your appointment.
  1. Adult Intake Form (For patients over 12 years of age)
  2. Pediatric Intake Form (For patients 12 years of age and under)
  3. Chiropractic Intake Add On Form: This should be filled out in addition to the Elixir intake form for those seeking chiropractic services.
  4. Massage Only Intake Form: For those clients seeking massage services only.
Consent Forms:
These can be signed electronically through your patient portal or in the office prior to your appointment
  1. Notice of Privacy Practices
  2. Financial Policies
  3. Office Policies
  4. Consent for Treatment
  5. Tele-Health Consent
  6. COVID-19 Liability Waiver
  7. General Record Release 

What to Expect at your
First Appointment

Before arriving to your first appointment you will be asked to complete a detailed intake form. Answering the questions, to the best of your ability, will aid in providing you the best possible care. Please bring the appropriate form(s) to your first appointment. If you do not have these completed prior to your appointment you may need to be re-scheduled.
Naturopathic Medicine
An initial Naturopathic appointment will last approximately 45 minutes and consist of the following:

  • Review of intake form, health concerns, and pertinent health history
  • Investigation of nutritional, metabolic, mental/emotional, and/or physical imbalances
  • Thorough physical examination
  • Initial treatment plan
  • Time for questions
Acupuncture and Chinese Medicine
An initial Acupuncture and Chinese medicine appointment will last approximately 1.5-2 hours and consist of the following:

  • Intake form review
  • Investigation of Chinese medicine patterns
  • Tongue and pulse diagnosis
  • Initial treatment plan
  • Initial Treatment
  • Time for questions
Chiropractic Services

An initial Chiropractic appointment will last approximately 45-60 minutes and consist of the following:

Massage Therapy
An initial Massage therapy appointment will last the length scheduled (60 or 90 minutes) and consist of the following:

  • Review of intake form and pertinent history
  • Discussion of concerns and problem areas
  • Massage therapy using modalities and techniques deemed most appropriate.


Schedule an Appointment Online


Elixir: A Wellness Collective

2146 NE 4th St #160
Bend, OR 97701
541.306.4471 phone
541.566.7493 fax
[email protected]

Hours: 9am to 6pm Monday-Friday 

*Closing at 4pm on Friday temporarily

Closed for lunch from 1pm to 2pm

To schedule an appointment login to the

Elixir Bend