Please scroll down for all forms.
Arthritis
Cardiology
- Patient Registration Form
- Consent to Release Information
- Fee for Records Policy
- New Patient Appointment Letter
- Privacy Policy
- No show/Cancellation Policy
Diabetes & Nutrition
- D&N – WWMG Patient Demographics Form
- D&N – Self Assessment of Diabetes Management
- D&N – WWMG Consent to Release Information to Friends and Family
- D&N – WWMG Financial Agreement and No-Show Fee
- D&N – WWMG Notice of Privacy Practices and Acknowledgement Form
- D&N – Patient No-Show and Appointment Cancellation Policy
Ear, Nose and Throat / Allergy / Audiology
- Welcome Letter
- Medical Questionnaire
- Audiology Questionnaire
- HIPAA Signature Page
- Cancellation Policy
- WWMG-financial-agreement
Endocrinology Center
- Patient Medical History Form
- Patient Registration Form
- Medication Flowsheet
- Financial Agreement
- Acknowledgement of Privacy Practices
- Patient No-Show/Cancellation Policy
Family Practice
Everett Family Medicine
- Patient Registration Form
- Patient History – New Patients
- Everett Family Medicine Prescription Refill
- Privacy Policy
- Notice of Privacy Practices
- Consent to Release Information
- No Show Policy
- Consent to Treat a Minor
- Financial_agreement
- EFM – Authorization for Release of Information Form 2018
- PHQ.9 Form – EFM
- Generalized Anxiety Disorder Screening (GAD-7) – EFM
- PHQ-A for adolescents
Lake Serene Clinic – Lynnwood
- Patient Registration Form
- DOT Physicals
- Parental Consent Form
- MVA Payment Authorization
- PHI Disclosure Authorization
- Routine Preventative Healthcare Checklist
- Wellness Exam Insurance Info
- Privacy Policy
- No Show Policy
Marysville Family Medicine
- Adult Preventative Care 2018
- New Patient Packet
- Integrative Medicine Intake Form
- Consent to Treat a Minor
- Release of Information
- FMLA Disability Information Worksheet
Snohomish Family Medicine
- DOT Exam Checklist
- No Show Policy
- SFMC-NPT-Female
- SFMC-NPT-Male
- SFMC-Pediatric-Female
- SFMC-Pediatric-Male
- Wellness Forms Female
- Wellness Forms Male
Whitehorse Family Medicine – Arlington
- New-Patient-Packet-WFM-2
- 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
- Med Hx Form
- COMM-Current Opioid Misuse Measure
- Generalized Anxiety Disorder Screening (GAD-7)
- PHQ.9 Form
- PHQ-A for adolescents
- Consent For Flu Vaccine
Gastroenterology / Endoscopy
Nephrology
- New Patient Instructions
- Patient Registration Form
- Health History
- Financial Agreement – Nephrology
- No Show and Cancellation Policy
- Consent_to_release_information
- Privacy Policy
- Acknowledgement of Receipt of Notice of Privacy Practices
Orthopedic
Podiatry
- Podiatry-New-Patient-Packet-1
- Notice of Privacy Practices
- Consent For Minors – Podiatry
- Authorization for Release of Information
- Refurbishment of Orthotics
Psychology
Pulmonary / Asthma
- Appointment Policy – Pulm
- Patient Registration Form
- Consent to Release
- WWMG Financial Agreement
- General Information
- General Edmonds Information
- PATIENT HISTORY QUESTIONNAIRE
- Patient Health History
- Privacy Policy
- Acknowledgement of Privacy Practices
Rheumatology
- Patient Registration Form
- WWMG Financial Agreement
- Patient Health History
- Release of Records Authorization
Sleep Medicine
- Appointment Policy – Sleep Medicine
- Patient Registration Form
- Cognitive Behavioral Therapy for Insomnia
- Consent to Release
- WWMG Financial Agreement
- General Information
- Sleep Medicine General Information
- Patient Questionnaire
- Patient Health History
- Sleep Questionnaire
- Privacy Policy
- Acknowledgement of Privacy Practices
Surgery Center