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Adult Patient Intake Forms

(Please print all forms and fill out completely)

Child/Teen Patient Intake Forms

(Please print all forms and fill out completely)

Currently Accepting New Patients!

 

---- "I wanted to send a big thanks to you. Being under your care has greatly improved my life (after virtually no improvement over the last 15 years)! You are making a difference!" ---- A Satisfied Patient

Thank you for choosing Queen Anne Naturopathic Center! We look forward to joining you on your journey to optimal health.

Insurance

We currently accept: 

  • Regence Blue Shield

  • Premera Blue Cross

  • Anthem Blue Cross Blue Shield

  • Uniform Medical Plan

  • Personal Injury Protection (PIP) claims

Payment

We accept Visa, Mastercard, American Express, local checks and cash payment at time of service. Please be advised a 4% processing fee is applied to all credit and debit card transactions.

New Patient Forms

Prior to your first office visit, please print and complete the appropriate Patient Intake Forms found below. Also, please read the Dispensary Etiquette form. Bring completed forms, as well as a photo ID and your insurance card, if applicable, to your first office visit. 

 

New patients and current patients with insurance and/or address changes should plan to arrive 15 minutes prior to your appointment time to complete any necessary paperwork.

 

Late For Your Appointment?

If you are delayed or lost on the way to your appointment, please call (206) 281-4282 as soon as possible to let us know.

Dispensary Etiquette

(All patients - please read)

© 2017 by Queen Anne Naturopathic Center. Created with Wix.com

To Schedule An Appointment

Call 206.281.4282

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