New patients:
For your first visit, you will need to fill out a few forms. To save time, you can download these forms here and print them using Adobe Acrobat Reader.
Patient Profile packet (please fill out and bring with you)
Pediatric Patient Profile packet (for patients under the age of 18)
Returning patients:
To keep track of our progress during return visits, I would like for you to fill out this form:
Follow-up Form
Insurance reimbursement:
Depending on your health insurance provider, you may be able to get reimbursed for my services.
To apply for insurance reimbursement, you will need a copy of the receipt that I give to you at the end of our visit and one of the member claim forms below.
Please use the form that corresponds with your insurance provider.
Otherwise, you can check your insurance company's web site for appropriate member claim forms.
Regence Blue Shield member claim form (© 2006 The Regence Group)
Premera Blue Cross member claim form (© 2006 Premera Blue Cross)
Lifewise of Washington member claim form (© 2006 Lifewise of Washington)
Uniform Health Plan member claim form (© 2006 State of Washington)
Reminder: You will need Adobe Acrobat Reader to view and print these forms.
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