Important Practice Update. Read Now!

dr. Geoff Lecovin
dr. Geoff Lecovin
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  • About Us
  • Services
    • Naturopathic Medicine
    • Chiropractic
    • Acupuncture
    • Corrective Exercises
    • Performance Nutrition
    • Neshamah Journey
  • Patients
    • Patient Forms
    • Online Payments
    • Online Scheduling
  • Articles & Blog
  • Contact Us
  • More
    • Home
    • About Us
    • Services
      • Naturopathic Medicine
      • Chiropractic
      • Acupuncture
      • Corrective Exercises
      • Performance Nutrition
      • Neshamah Journey
    • Patients
      • Patient Forms
      • Online Payments
      • Online Scheduling
    • Articles & Blog
    • Contact Us
  • Home
  • About Us
  • Services
    • Naturopathic Medicine
    • Chiropractic
    • Acupuncture
    • Corrective Exercises
    • Performance Nutrition
    • Neshamah Journey
  • Patients
    • Patient Forms
    • Online Payments
    • Online Scheduling
  • Articles & Blog
  • Contact Us
Patients

Patient forms

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.

Contact Dr. Lecovin

NEW PATIENTS

Patient Registration (pdf)

Download

Patient Health History (pdf)

Download

Financial Policy (pdf)

Download

Insurance Benefits (pdf)

Download

Informed Consent (pdf)

Download

Privacy Practices (pdf)

Download

ADDITIONAL FORMS FOR Acupuncture Patients

Acupucture - Notification (pdf)

Download

Acupuncture - Waiver (pdf)

Download

ADDITIONAL FORMS FOR CAR ACCIDENT (MVA)

MVA Verification (pdf)

Download

WORKER’S COMPENSATION (L&I) PATIENTS

L&I Verification (pdf)

Download

#eatmove&performbetter

Contact Us

Dr. Geoff Lecovin

425.999.4484

staff@drgeofflecovin.com


284 Central Way

Kirkland, WA 98033

Hours

Open today

07:00 am – 04:30 pm

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