Forms
For all new patients
Record Release Form - Please fill this out and send it to your current doctor
Notice of Privacy Practice
Consent
Consent to Discuss Medical Information
Consent to Treat Minor
Consent to Release Records/Transfer of Care - Please fill this out and send to us
Consent for Virtual Visits
Patient intake forms
Acupuncture Intake Form - Please fill this out before your first acupuncture appointment
ND Intake Form - Please fill this out when you are seeing one of our ND’s for the first time
Physical Medicine Intake Form - Please fill this out when you will be receiving massage and/or spinal manipulations
MVA Paperwork - Please fill out this packet if you are being treated due to a motor vehicle accident
Athletic & Camp forms
School Sports/Camp Physical Questionnaire - Submit this form to us along with school's form
Lake Washington - High School and Middle School forms
Northshore - High School and Middle School forms
Bellevue - High School and Middle School forms - Forms not readily available, must login to BSD
The Bear Creek School
Authorization for Medication
Medication Administration Questionnaire - Submit this form to us along with school's form
Lake Washington
Northshore
Bellevue
The Bear Creek School
Immunization Records
Access Family Immunization Records (wa.gov, choose option 1)