An Explanation of Patient Resources

For your convenience we have attached forms that are be necessary to be completed before your first visit with your doctor.  Please open and print the New Patient Registration form and Comprehesive Patient Health History form. 

Patient information and privacy are very important to us.  We have included your Patient Privacy Rights or better known, HIPPA guidelines.  Please read the Privacy Right statement and print the Authorization and Acknowledgement form. 

The Authorization and Acknowledgement form will allow our staff to speak to members of your family or friends regarding your health care.  Included in this authorization statement is our brief Financial Agreement and when to request a Referral from your primary care doctor. 

Please sign each respective area after reading.  If you have any questions regarding this form, please do not hesitate to bring the form with you at the time of your office visit and a member of our staff will be happy to help or explain any inquiry you may have. 

 Forms

 Registration Form

New Patient Comprehensive Health History Page 1
New Patient Comprehensive Health History Page 2

Notice of Privacy HIPAA Rights

Premera Incident Report Form

Regence Incident Report Form

LNI Application to Reopen Claim - English

LNI Application to Reopen Claim - Spanish

Release of Medical Records

Consent to Treat a Minor

MRI Questionnaire - English

MRI Questionnaire - Spanish