Phone (425) 423-0878     Fax (425) 669-9538       Click here for location and Operating hours.     Click here to book your appointment.

Form Repository

We provide a variety of forms online for the convenience of our patients.

Appointment Request Form

  • Click on the Appointment Request Form to request a new or follow up appointment.

New Patient Forms

Online New Patient Forms - Standard

Online New Patient Forms - Mobile or Poor Vision

Iron IV Referral - New Patient Form - Only for patients referred by an outside physician.

Consent and Release Forms - Fillable Online

Release of Records - To Us from an outside individual or clinic - Use this form if you need a previous provider to forward your records to us for your new patient or continuing care.

Release of Records - From us to Outside Individual or Clinic  - Use this form if you need us to send forms to another clinic or individual (including yourself).

Authorization to Communicate Freely with Representative - This form assigns an individual with the right to receive details on your health records, diagnosis and speak on your behalf on your current health concerns.  Please review carefully as you are opting out of certain privacy protections by completing and submitting this form.