Registration Paperwork

Print and fill out the following forms prior to your first visit.

• Demographic Form
• Health History
• Treatment Consent
• Patient Policies
• Insurance Coverage Checklist
• Notice Of Privacy Practices and Acknowledgement 
• Communication consent 

Breast Thermography Paperwork

Print and fill out the following forms prior to your thermography appointment.  If you are a new patient to the clinic, please also fill out the registration paperwork above.

• Thermography Appointment Preparation Information 
• Breast History
• Thermascan Privacy Practices 

Request for Records

• Records Release
• Records Release - Everett Clinic ONLY

Other

• Bio-Identical Hormone Replacement Therapy: Risk Assessment