Patient Forms

New patients, please review and complete forms below prior to your first visit:

  • Patient Information ( PDF )
  • Patient Insurance Benefits ( PDF )
  • General Insurance & Financial Policy ( PDF )
  • Informed Consent ( PDF )
  • Privacy Practices ( PDF )
  • Health History ( PDF )

Acupuncture patients, in addition to the forms above, please review and complete forms below:

  • Acupuncture Notification ( PDF )
  • Acupuncture Waiver ( PDF )

 

Download Instructions:

By clicking on the above links, the form may open in your web browser.  Right click and select download to your computer.  You
may then open up using Adobe Acrobat Reader to complete form on computer.  Print out and bring with to appointment or you
can fax to (425) 999-4484

We do not accept these forms via standard email due to HIPPA privacy requirements.