Additional Patient Forms
Below you will find additional forms that we use in our clinic. Feel free to download and fill out these forms at home to ease your first visit:
- CCM Immunization Confirmation Letter
- School Immunization Questionaire
- Treatment Consent Form
- Acknowledgement of Review of Notice of Privacy Practices
- AMA-against medical advice
- Medical Record Authorization Form
- Health History Form
- WA Immunization Exemption Certificate
- Insurance and Payment Authorization
- Patient Heath History Form
- Pre-Participation Physical Evaluation
- Medical Release Form
- Patient HIPAA Notice
- Denver II Developmental
- More Forms on WA DOH
These forms are in PDF format which requires Adobe Acrobat Reader. Click
to download the free plug-in.