Forms

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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

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
Neurofeedback Questionnaire - For first time NF patients
Thermography - Procedure Preparation Instructions, please follow these guidelines when seeing Nurse Andi for Thermography
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
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 - Please check with school for this form