Jennifer is out of the office 
October 29th-November 11th! 


Register with Functional Medicine of Bend PC

Welcome to the Functional Medicine of Bend PC registration page. To register as a new patient, please enter your information in the fields below. Please do not use this form if you are already a patient (you have seen any of our practitioners in the past). To set up patient portal access or amend your information, please contact us.

If you are already a registered patient with online access, you can log in here

Basic Contact Information

Your Address

Contact Information

Emergency Contact

Insurance Information

Our office will bill your insurance(s) as a courtesy. Please remember that outstanding balances not paid or delayed by insurance processing are patient responsibility and due within 60 days from date of service. We also expect patient responsibility to be paid at the time of the visit (deductible, coinsurance, copay).

Medical Information

Please enter your basic medical information below. You may also add or edit this information after you've signed up.

Set Username and Password for Patient Portal

Please create a username and password that you will use to log into the patient portal in the future.

Your username must be at least 4 characters long

Your password must be at least 8 characters long and include at least one number or special character.

The patient portal gives you access to your medical records and lets you securely communicate with your doctors. When you sign up, you will receive an email with instructions for logging in.

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