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
Clinical Laboratory
Diabetes & Nutrition
Ear, Nose and Throat / Allergy / Audiology
- Welcome Letter
- Patient Registration Form
- Medical Questionnaire
- Audiology Questionnaire
- Allergy Testing Questionnaire
- HIPAA Signature Page
- Cancellation Policy
- Financial Policy
- Everett ENT Records Request Form
Endocrinology Center
- New Patient Welcome Letter
- 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
- Patient History – New Patients
- Privacy Policy
- Notice of Privacy Practices
- Consent to Release Information
- No Show Policy
- Consent to Treat a Minor
- Office/Financial Agreement
- EFM – Authorization for Release of Information Form 2018
Lake Serene Clinic
- New Patient Registration
- 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
Snohomish Family Medicine
- DOT Exam Checklist
- DOT Exam Report
- Medical Examiner Certificate
- No Show Policy
- SFMC NPT Female
- SFMC NPT Male
- SFMC Pediatric Female
- SFMC Pediatric Male
- Wellness Forms Female
- Wellness Forms Male
Whitehorse Family Medicine
- Packet for Minors – This packet is specifically for patients under the age of 18.
- Packet for Adults
- Consent to Treat a Minor
- Authorization to Release Records
- No Show Policy
Gastroenterology / Endoscopy
Nephrology
- New Patient Instructions
- Patient Registration
- Health History
- Financial Agreement
- Consent to Release Information
- Patient No Show Policy
- Privacy Policy
- Acknowledgement of Receipt of Notice of Privacy Practices
Orthopedic
Podiatry
- New Patient Packet
- Notice of Privacy Practices
- Consent for Minors
- Authorization for Release of Information
- Refurbishment of Orthotics
Psychology
Pulmonary / Asthma
- Appointment Policy – Pulmonary
- Patient Registration Form
- Consent to Release
- Financial Agreement
- General Information
- General Information Edmonds
- Patient Questionnaire
- Patient Health History
- Privacy Policy
- Acknowledgement of Privacy Practices
Rheumatology
- Patient Registration Form
- Financial Agreement
- Patient Health History
- Release of Records Authorization
Sleep Medicine
- Appointment Policy – Pulmonary
- Patient Registration Form
- Consent to Release
- Financial Agreement
- General Information
- General Information Edmonds
- Patient Questionnaire
- Patient Health History
- Sleep Questionaire
- Privacy Policy
- Acknowledgement of Privacy Practices
Surgery Center