elemental medicine
​2915 SE Belmont, #1
Phone: 503.505.9677
​Fax: 503.427.9765
contact@elementalmedicinepdx.com
  • Home
  • Chiropractic
    • Chiropractic FAQs
    • Forms and Fees
    • Specialties
  • Fascial Manipulation©
    • Forms and Fees
  • Acupuncture
    • Acupuncture FAQs
    • Forms and Fees
  • Massage Therapy
    • Carrie Ebling DC, LMT #8058
    • Forms and Fees
  • Schedule an Appointment
    • Contact & Hours
    • Insurance Billing FAQs
  • Membership
    • 30-minute Chiropractic Enthusiast
    • 60-minute Acupuncture Enthusiast
    • 60-minute Massage Enthusiast

New Patient Registration Packet (6 pages)

These forms provide the office with all of your contact information, outlines the financial obligations and is the privacy policy and consent form.  Also included is a health history form where you can indicate your current area of complaint, as well as a brief history of your past injuries, illnesses, medications and accidents.  It is 6 pages in length.

Fees for payment in full at time of service:

Fascial Manipulation:  $125 / 45 minutes

Missed Appointments: There is a $50 charge for cancellations within 24 hours of your scheduled appointment time.



Student and Senior Discount: $100 for Fascial Manipulation appointments

For additional information, email contact@elementalmedicinepdx.com.

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