Forms

If you have scheduled an initial visit at Emerald City Clinic, you will be asked to join our patient portal, Charm. If you are not able to get to that website, please print and fill out each of the following forms, and bring them with you to your appointment. One of these...

• Adult Intake Form-OR-Child or Dependent Intake Form

...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. Please call the office with any questions you may have. Thank you!

• Questions to ask your insurance: Naturopathic care only

• Informed Consent

• Email Policy - Informed Consent

• Notice of Privacy Practices - Acknowledgement

• Notice of Privacy Practices

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.

• Medical Records Release Form