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

Form Repository

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

Mailing List

Click here to sign up for our mailing list.

New Patient Forms

Online New Patient Forms

Demographic Updates

Complete this form to update address, insurance information, phone number, email, name change, etc by clicking here.

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.

Physician Forms

Please visit our Physician Page for IV Therapy Referrals for additional information.