Print out and bring all forms to your appointment or fax to (425) 999-4484. We do not accept these forms via standard email due to HIPPA privacy requirements.
Patient Registration (pdf)
Patient Health History (pdf)
Financial Policy (pdf)
Insurance Benefits (pdf)
Informed Consent (pdf)
Privacy Practices (pdf)
Acupucture - Notification (pdf)
Acupuncture - Waiver (pdf)
425.999.4484
staff@drgeofflecovin.com
284 Central Way
Kirkland, WA 98033
Copyright © 2020 Dr Geoff Lecovin - All Rights Reserved.