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Meet
the Doctors
Preventive
Medicine — |
NEW PATIENT FORMS Dear Patients, We are accepting new patients and accept Regence Blue Shield, and Premera Blue Cross/LIfewise health insurances. We accept Visa, MasterCard, American Express, cash and checks for payment of services. For your first office visit, you will need to read the Welcome Letter from the doctor you will be seeing. Please print out, read and sign the Financial Policy page. Please print out and fill out the Patient Profile and Health History pages, as well as the Symptom History and Family History forms. Please bring all the printed out forms to the office. If you are a new patient and have health insurance we accept, or have had changes in insurance information we have on file, please come in 15 min. early to complete any necessary paperwork. If you are delayed for your appointment or lost, please call (206) 281-4282 as soon as possible. Thank
You, Forms:
(All patients — please print out, read & sign, and bring to your appointment) - (Please choose one of the following intake forms, fill out and bring to your appointment) -
(If your intake form above includes a health history, please also fill out these forms and bring to your appointment) - Please note: If you're having problems downloading these forms, you may need to download free Acrobat Reader software. Click here to download free Acrobat Reader
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315 First Avenue West, #A, Seattle, WA. 98119 206.281.4282 |
