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2025 - 112th Ave. NE
Bldg 2 - Suite 300
Bellevue, WA 98004
ph: 425-452-9366
fax: 425-452-5683
The doctor of the
future will give
no medicine, but interest his patients
in the care of the
human body,
in diet, and
in the cause and prevention of
disease."
~ Thomas Edison ~
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The following forms are available for your convenience. New Patients should
fill out the forms and bring to first office visit.
Health History Form |
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You have the option to: |
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1) Print the blank form as is and complete it later with a pen or pencil; or |
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2) Fill out all or part of the form online and then Print the form containing
the information you entered. |
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** Note: In option #2, you will not be able to Save the entered information to a File.
However you can add to or correct the printed information with a pen
or pencil as needed at a later date |
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Patient Information / Insurance / Office Policies Forms |
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There are three separate forms in this PDF file. Print them out, fill in
information by pen or pencil, and bring to your first office visit. |
These forms require Adobe Reader. If you need to install Adobe Reader, it is available to download and install free of charge at the
following link...Note: Select "Run" in the popup window.
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