| Release of Medical Records Form | Release of Medical Records Form |
| Patient Registration Form | Patient Registration Form |
| HIPAA Privacy Notice | HIPAA Privacy Notice |
| Notice of Privacy Practices Acknowledgement Form | Notice of Privacy Practices Acknowledgement Form |
New Patient Forms–English
Below you will find new patient forms that we use in our clinic. Feel free to download the forms and fill out these forms at home to ease your first visit:
- Patient Contact Form
- Patient Registration Form
- Notice of HIPAA Practice Policy
- Notice of Privacy Policy
- Medical Release Form
- Change PCP forms
New Patient Forms–En Espanol
- Patient Registration Form
- Reglamento Financiero (Financial Policy)
- Historia De Salud De Su Hijo (Patient Health History)
- New Patient Brochure
Additional Patient Forms
Below you will find additional forms that we use in our clinic. Feel free to download and fill out these forms at home to ease your first visit:
- CCM Immunization Confirmation Letter
- School Immunization Questionaire
- Treatment Consent Form
- Acknowledgement of Review of Notice of Privacy Practices
- AMA-against medical advice
- Medical Record Authorization Form
- Health History Form
- WA Immunization Exemption Certificate
- Insurance and Payment Authorization
- Patient Heath History Form
- Pre-Participation Physical Evaluation
- Medical Release Form
- Patient HIPAA Notice
- Denver II Developmental
- More Forms on WA DOH
