Forms

PDF Forms (all PDF Downloads)

Packets

Member Registration Packet  (for adults and dependents ages 13 and up – one per person)

Dependent Registration Sheet (simple sheet for any dependents age 12 and younger – up to 5 per sheet)

Individual Forms for Reference Only! The above packet assumes agreement with all forms below.

Patient Agreement

Billing Information & Authorization

Authorization to Email Protected Health Information

Acknowledgement of Privacy Practices

Medicare Statement of Understanding (only for those eligible for Medicare, typically those 65 and older)

Online Information

List of Patient Services

Service Cancellation Form

If you can’t find what you’re looking for, you can always contact us here, or call our office at 509-823-4650.

Thanks!