New Patient Information and Forms

Scheduling an Appointment 
To schedule an appointment  please call 360-385-4843  We are also pleased to provide online scheduling at . Our fees and times of appointments are regularly updated online.

Intake forms: please see below for links to forms that can be faxed securely to us, mailed or simply brought in.

NOTICE to Potential Patients who have state administered insurance:  Medicaid, Apple Health,  Basic Health,  L&I,  etc.  If you have a state administered health plan   
Please click the following link:  Memo about Washington State plans.

After the physician listens to your medical history and provides a pertinent physical exam, he/she can advise you of your health care choices. We expect new patients to feel well listened to.  Our plans for pain management and addictions are intended to be practical and workable.  For your first visit expect to be at the office for at least an hour.  Please do not expect to have prescriptions for controlled substances filled during the first consultative visit. 


Payment options for patients seeking specialized care in pain management or treatment of addictions.  Please follow the Link to the memo describing one's options. 

Payment by cash, checks, or credit card is expected at the time of the visit unless other arrangements have been made.  While we are prepared to help bill third parties we do not have any formal agreements with private insurers.  Medicare is the only third party carrier we have an agreement with.

A physician is available by phone, generally within 24 hours,  for established patients encountering concerns regarding their treatment plan. 

Please call the office number for instructions on how best to contact our physician.   

Forms related to your First Visit  (and some related to ongoing care)
These forms can be printed out and then completed and returned via mail, fax, or in person.  If reading skills or other issues preclude one's ability to complete these forms please let the receptionist/scheduler know.  The forms marked with a "*" are especially helpful to be completed or reviewed prior to your first visit.   We deeply regret the number of forms and questionnaires required in order to be seen.  They are largely the direct result of third party and regulatory involvement in medical care.  They represent just the tip of the iceberg regarding costs and liabilities associated with same.

*Welcome Memo
*Intake Form - Demographics
*Brief Medical History Questionnaire
*Payment Policies Form to be Signed
Notice of Privacy Practices  (Please Read and sign acknowledgement form at end)
Disclaimer regarding outside lab testing

Pain and Activity Questionnaire
Patient Health Questionnaire (PHQ)
AUDIT Alcohol use screener
GAD-7 Anxiety Screener

MEMO:  Regarding OPAS Billing Third Parties
Release of Healthcare  (useful for records to be sent from one provider to another)
OPAS Policies regarding prescription refills and prior authorizations