Appointment Request/Forms
If you are ready to schedule a first appointment,
please select the link below and fill out this brief form in its entirety.
Our Intake Coordinator will contact you within a few business days after receiving the form.
Click HERE to access this form.
Our Intake Coordinator will email you additional forms we need you to complete once we have secured an appointment date and time. If you prefer, you may also drop by the office to pick up and complete a paper copy of these forms.
Below is another link to important information about this office, policies, consenting for care, and how your health care information is managed. As we progress through the process,
you will sign a form stating you have received and reviewed the information contained within.
Office Policies, Informed Consent, and Protecting the Privacy of Your Healthcare Record
Please take a few minutes and review this document. You are welcome to print the above form for personal reference, or request a copy at any time.
Occasionally, you may be instructed to complete additional forms or there may be tests needed in the course of your evaluation and treatment. Your clinician will speak with you about these forms and tests.
When you fill out any of our forms online, they are forwarded to a secure HIPAA-compliant server
to protect your privacy. You may ask for reprints of any form at any time.
Notice to Patients/Clients
Clinicians contracting with NWPR may be trainees under licensed supervision,
or are licensed clinicians under contract with the National Health Services Corps.
Clinicians serve all consumers regardless of ability to pay.
Discounts for essential services are offered based on family size and income.
For more information, discuss this with our intake coordinator.
360-414-8600 x114
Thank you.
