Forms

If you have scheduled an initial visit at Emerald City Clinic, please print and fill out each of the following forms, and bring them with you to your appointment.

One of these…

…and each of the following. If you will be seeing one of our practitioners who is contracted with insurance, please be sure to fill out the “Questions to ask your insurance company” form prior to your appointment. If you will be receiving acupuncture treatments, or think that you may in the future, please fill out the indicated form. Please call the office with any questions you may have. Thank you!

If you have medical records from previous medical practitioners that you would like your Emerald City Clinic doctor to review prior to your First Office Call, please download, fill out, and send to that provider. If you would like Emerald City Clinic to send records to another provider, fill out the second form listed and send to Emerald City Clinic. Please keep in mind that it is standard for medical records to take 2-3 weeks to arrive.