Patient Forms

Each patient must fill out the new patient registration forms prior to their first appointment. You may download a printer-friendly version on our website or request that we mail or fax them to you. Please arrive at your appointment 10-15 minutes early to fill out this paperwork if you do not do so before hand. Also, please bring your insurance card(s) with you to your first appointment.

 

 

 

Health History Form - To be completed by all new patients and once a year thereafter to ensure we have accurate information in order to best serve you. Not for Dr. Trumble patients.

New Problem Intake Sheet - To be completed with each new issue addressed with existing patients only. Not for Dr. Trumble patients.

Dr. Trumble's New Patient Intake Form - Please only use this form if you are seeing Dr. Tom Trumble as a new patient.

Dr. Trumble's Existing Patient Form - Please fill out this form if you are seeing Dr. Trumble for a follow up visit

Hippa Privacy Act - To be signed by all new patients and once a year thereafter to be sure we are complying with all privacy laws.

Serving the Bellevue, Kirkland and Redmond Areas