New Patient Forms

Consent Form

Please read this information carefully, and ask your practitioner if there is anything that you do not understand.

Download PDF Consent Form

Health History

Your answers on this form will help your provider understand your medical concerns and conditions better.

Download PDF Health History Form

Health Information Privacy (HIPAA)

This notice describes our office’s policy for how medical information about you may be used and disclosed, how you can get access to this information, and how your privacy is being protected.

Download PDF HIPAA Form

Financial Policy & Fee Schedule

This form describes specific services, fees and important information concerning insurance and payment policies.

Download PDF Financial Policy Form

Scope of Practice & Qualifications

This form describes the scope of practice for an East Asian Medicine Practitioner (EAMP, formerly designated L.Ac.), as defined by Washington State, and the qualifications of your practitioner.

Download PDF Scope Notification