Holistic Health Clinic
Motor Vehicle Accident Intake
CHIEF COMPLAINT #1
CHIEF COMPLAINT #2
PLEASE MARK WHERE YOUR PAIN IS LOCATED. USE THE FOLLOWING KEY:
B= Burning S= Stabbing A= Aching N= Numbness P= Pins and Needles O= Other
10:00 am - 7:00 pm
10:00 am - 5:00 pm
4670 SW Washington Ave Beaverton, OR 97005
(503) 526-0783
[email protected]