Back to Function
Back to Life
Serving the South Puget Sound region for 40 years

Patient Forms

For your convenience, you can download the patient forms and complete them prior to your first visit. Then, bring the forms with you when you come in for your appointment. If you choose to fill out the patient form packet at our office, please arrive 30 minutes before your appointment to allow enough time to get them completed. Our forms are PDF files. To download and print the forms, you’ll need the free Adobe Acrobat Reader program. Please download and complete:
  1. Patient Intake Forms
    a. Initial Questionnaire- All patients
    b. Release of Benefits – All patients
    c. Labor & Industries- Attendance policy
    d. Labor & Industries- Prior treatment questionnaire
  2. Download and complete the form that pertains to the condition we are treating:
  3. Review our Notice of Privacy Practices and Print out Acknowledgement – bring with you to your Appointment
    a. Notice of Privacy Practices
  4. Have your physician download and complete our Physican Referral and fax it to the clinic nearest you. Fax numbers are on the 2nd page of the referral form.