Patient Forms

Download Patient Forms

Before your appointment with us, quickly and conveniently access patient forms from our practice.

To view the forms listed below, you will need to download Adobe Reader. Please bring your completed forms with you to our office at the time of your visit.

What to Bring to Your Appointment

  • A list of medications including the dose and frequency
  • Any recent x-rays or lab results related to your condition
  • Pertinent information about your medical and surgical history
  • Personal ID (driver’s license)
  • Physician referral form if required by your insurance provider
  • Your insurance card

Insurance Billing

We are a provider for Medicare and most major insurance plans. We provide insurance billing. Anything not covered by insurance will be your responsibility. We request payment at the time of your appointment for services that are not covered by insurance. Your insurance company may also require you to pay a co-payment at the time of your appointment. When necessary, our staff will work closely with patients who require a payment plan. If you have any questions regarding which insurance plans we accept or any patient billing concerns, please call us at 253-833-4050. Questions regarding your coverage and benefits should be directed to your employer or insurance company.

Resources — Find out more about common Ear, Nose and Throat diseases — Find out more about your doctors in the Washington State Medical Association — Find out more about the academy of Head & Neck Surgery, including some of the latest treatments found at Surgical Associates Northwest, ENT Division