Patient Forms for all WWMG Practices

Cardiology

• Patient forms for Cardiology can be filled out in MyChart or they can be verified at check-in for your appointment (please arrive a few minutes early).
• Cardiology Patient No-Show and Cancellation Policy

Ear, Nose and Throat / Allergy / Audiology

• Medical History Questionnaire – ENT 

Endocrinology

• Patient Medical History Form
• Patient Registration Form
• Medication Flowsheet
• Appointment Policy

Family Practice Primary Care:

Everett Family Medicine

• Patient Registration Form
• Patient History – New Patients
• Everett Family Medicine Prescription Refill 
• Notice of Privacy Practices
• Consent to Release Information
• No Show Policy
• Consent to Treat a Minor
• Financial Agreement
• Authorization for Release of Information Form
• Patient Health Questionnaire for adults
• Patient Health Questionnaire for adolescents
• Generalized Anxiety Disorder Screening

Grove Street Family Clinic – Marysville

• Patient Registration Forms

Lake Serene Clinic – Lynnwood

• Patient forms for Lake Serene Clinic can be filled out in MyChart or at the reception desk when you check in for your appointment (please arrive 15 minutes early).

Marysville Family Medicine

• Adult Medical History Form
• New Patient Packet
• Integrative Medicine Intake Form
• Consent to Treat a Minor
• Release of Information
• FMLA Disability Information Worksheet

Snohomish Family Medicine

• Release of Information 
• DOT Exam Checklist
• No Show Policy
• Patient Registration Form – Female
• Patient Registration Form – Male
• Pediatric Patient Registration Form – Female
• Pediatric Patient Registration Form – Male
• Wellness Forms Female
• Wellness Forms Male

Whitehorse Family Medicine – Arlington

• New Patient Registration Packet
• WWMG Family Friends Consent
• Consent to Treat a Minor
• DOT Appt letter-WFM
• Wellness Exam – Female
• Wellness Exam – Male
• Review of Systems
• Pain Inventory Handout
• Medical History Form
• COMM-Current Opioid Misuse Measure
• Generalized Anxiety Disorder Screening
• Patient Health Questionnaire form for adults
• Patient Health Questionnaire for adolescents
• Consent For Flu Vaccine
• Medical Records Release Form

Gastroenterology / Endoscopy

• New Patients: Forms for GI Office Visits
• New Patients: Forms for GI Procedures @ WWMG Endoscopy Center
• New Patients: Forms for GI Procedures @ Providence
• Release of Records Authorization
• Preparing for a Procedure? Click here for instructions

Imaging Center

• Imaging Center Referral Form

Nephrology

• Welcome Letter
• Patient Registration Form
• Health History
• Financial Agreement – Nephrology
• No Show and Cancellation Policy
• Consent to release information
• Notice of Privacy Practices
• Acknowledgement of Receipt of Notice of Privacy Practices

Orthopedic, Sports, Spine & Hand

• Orthopedic Intake Forms
• Spine Intake Forms
• Physiatry Intake Forms
• Records Release

Podiatry

• Patient Registration Form
• Refurbishment of Orthotics

Psychology

• Patient Registration Form

Pulmonary / Asthma

• Pulmonary Appointment Policy
• Patient Registration Form
• Consent to Release Information
• WWMG Financial Agreement
• General Information
• General Edmonds Information
• Patient History Questionnaire
• Patient Health History
• Notice of Privacy Practices
• Acknowledgement of Privacy Practices

Rheumatology

• Patient Registration Form
• WWMG Financial Agreement
• Release of Records Authorization
• Patient Health History

Sleep Medicine

• Sleep Medicine Appointment Policy
• Patient Registration Form
• Cognitive Behavioral Therapy for Insomnia
• Consent to Release Information
• WWMG Financial Agreement
• General Information
• Sleep Medicine General Information
• Patient Questionnaire
• Patient Health History
• Sleep Questionnaire
• Notice of Privacy Practices
• Acknowledgement of Privacy Practices

Surgery Center

• Patient Registration Form

Privacy Practices

• Notice of Privacy Practices

SMS Text Communications

By voluntarily providing your mobile phone number to WWMG, you agree to receive recurring non-marketing SMS text messages regarding appointment reminders, cancellation or rescheduling, patient onboarding, care-related notifications, and billing updates. Message frequency varies. Message and data rates may apply. Providing a mobile number and consenting to SMS text messages are not required to receive medical treatment or services from WWMG. Reply HELP for help or STOP to opt out. View the WWMG Privacy Policy and SMS Terms and Conditions.