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Patient Forms

We've gathered our patient registration, medical history forms and insurance information into one convenient location. Please complete the following:

Print and fill out the following forms:

Select one of the following forms that best fits your condition:

For multiple areas, please choose the area your most having issues with. If you are unsure of which form to fill out, please call our office at 425-486-6079.

2013 HIPAA Notice of Privacy Practices 

Insurance Information: We want you to be informed and confident with your insurance coverage and fiscal responsibility. By clicking on your insurance company you will be directed to their home page where you can login and gain access to your coverage and benefits. You may be responsible for a co-pay or deductible. If you have any questions or do not see your insurance company please call our office at 425-486-6079 and we will be happy to assist you.


Beech Street HealthNet Personal Injury Policy (PIP)
Blue Cross / Blue Shield KPS Health Plans - First Choice Premera
Blue Cross Blue Shield Federal Labor and Industries (WA State) Private Healthcare Systems
Carpenters Trust Labor and Industries (Federal) Regence
Cigna (PPO and POS Plans Only) Lifewise Regence Med Advantage
First Choice Megalife Uniform Medical
Pacificare United Health Care