Snohomish Valley Holistic Medicine Forms

Downloadable Forms

Below are links to most of the forms required for your first office visit as well as the Sliding-scale information and application

Attachments:
File	Description	File size
Adult Health History Questionnaire	Detailed health questionnaire for Naturopathic first office visit.	86 Kb
Pediatric Health History Questionnaire	Detailed health questionnaire (ages 0-12) for Naturopathic first office visit.	67 Kb
Patient Registration	Required for all first office visits.	73 Kb
Financial Policy and HIPAA Acknowledgement	Required for all first office visits.	137 Kb
Consent for Naturopathic Treatment	Required for Naturopathic first office visit with Dr. Bowker.	46 Kb
Notice of Privacy Practices / HIPAA Compliance	For your information (no need to print this file).	79 Kb
Sliding Fee Scale Policy	Information about our sliding scale available to financially qualified applicants.	217 Kb
Sliding Fee Scale Application	Application required for those who may qualify for sliding fee scale discount for Naturopathic Medical Services.	189 Kb
Acupuncture Intake Form	Required for all new acupuncture patients.	91 Kb