Patient Forms for all WWMG Practices

Cardiology

• Patient Registration Form
• Consent to Release Information
• Fee for Records Policy
• New Patient Appointment Letter
• Privacy Policy 

Ear, Nose and Throat / Allergy / Audiology

• Medical History Questionnaire – ENT
• Medical History Questionnaire – Allergy
• Communication Agreement
• Consent to Release Information

Endocrinology

• Patient Medical History Form
• Patient Registration Form
• Medication Flowsheet
• Appointment Policy

Family Practice Primary Care:

Everett Family Medicine

• Patient Registration Form
• Patient History – New Patients
• Everett Family Medicine Prescription Refill 
• Privacy Policy
• Notice of Privacy Practices
• Consent to Release Information
• No Show Policy
• Consent to Treat a Minor
• Financial Agreement
• Authorization for Release of Information Form
• Patient Health Questionnaire for adults
• Patient Health Questionnaire for adolescents
• Generalized Anxiety Disorder Screening

Grove Street Family Clinic – Marysville

• Patient Registration Forms

Lake Serene Clinic – Lynnwood

• Patient Registration Form
• 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 Medical History Form
• New Patient Packet
• Integrative Medicine Intake Form
• Consent to Treat a Minor
• Release of Information
• FMLA Disability Information Worksheet

Snohomish Family Medicine

• Release of Information 
• DOT Exam Checklist
• No Show Policy
• Patient Registration Form – Female
• Patient Registration Form – Male
• Pediatric Patient Registration Form – Female
• Pediatric Patient Registration Form – Male
• Wellness Forms Female 
• Wellness Forms Male 

Whitehorse Family Medicine – Arlington

• New Patient Registration Packet
• WWMG Family Friends Consent
• Consent to Treat a Minor
• DOT Appt letter-WFM
• Wellness Exam – Female
• Wellness Exam – Male
• Review of Systems
• Pain Inventory Handout
• Med Hx Form
• COMM-Current Opioid Misuse Measure
• Generalized Anxiety Disorder Screening
• Patient Health Questionnaire form for adults
• Patient Health Questionnaire for adolescents
• Consent For Flu Vaccine
• Medical Records Release Form

Gastroenterology / Endoscopy

• GI – Patient Forms
• Endoscopy – Patient Forms
• Release of Records Authorization
• Preparing for a Procedure? Click here for instructions

Nephrology

• Welcome Letter
• Patient Registration Form
• Health History
• Financial Agreement – Nephrology
• No Show and Cancellation Policy
• Consent to release information
• Privacy Policy
• Acknowledgement of Receipt of Notice of Privacy Practices

Nutrition & Diabetes Education

• Patient Registration Forms
• Self-Assessment of Diabetes Management

Orthopedic, Sports, Spine & Hand

• Orthopedic Intake Forms
• Spine Intake Forms
• Physiatry Intake Forms
• Records Release

Podiatry

• Podiatry New Patient Packet
• Notice of Privacy Practices
• Podiatry Consent For Minors
• Authorization for Release of Information
• Refurbishment of Orthotics

Psychology

• Patient Registration Form

Pulmonary / Asthma

• Pulmonary Appointment Policy
• Patient Registration Form
• Consent to Release Information
• WWMG Financial Agreement
• General Information
• General Edmonds Information
• Patient History Questionnaire
• Patient Health History
• Privacy Policy
• Acknowledgement of Privacy Practices

Rheumatology

• Patient Registration Form
• WWMG Financial Agreement
• Release of Records Authorization
• Review of Symptoms – Bothell patients only
• Patient Health History – Everett patients only

Sleep Medicine

• Sleep Medicine Appointment Policy
• Patient Registration Form
• Cognitive Behavioral Therapy for Insomnia
• Consent to Release Information
• WWMG Financial Agreement
• General Information
• Sleep Medicine General Information
• Patient Questionnaire
• Patient Health History
• Sleep Questionnaire
• Privacy Policy
• Acknowledgement of Privacy Practices

Surgery Center

• Patient Registration Form