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Family Physicians

  

Patient Information and Forms

We are pleased that you have selected Summit View Clinic for your medical care.
Please complete the New Patient Registration Form and bring it with you to your scheduled appointment.

New Patient Registration and Patient Policies Please download BOTH forms (Requires Adobe Reader that can be downloaded for free at Adobe.com)

Clinic Brochure - helpful information about our clinic. 
You can download and view it with Adobe Reader ... it is a trifold.

Patient Health Profile Form used for a physical or if this is your first visit to our clinic. 
Print out the form and fill it out in the comfort of your own home!
Bring it in with you for your appointment.

Healthcare Medical Release for Family Members - form for patient to sign so medical information can be shared with designated family members.

Declaration of Informed Consent for Minors - parents should use this form to allow treatment of minors at our facility in their absence.

Kinship Form for Informed consent for Minors - use this form to allow treatment of minors at our facility without a parent or guardian present. This is to be used by parents, legal guardians, and those who have signed authorization to make health care decisions.

DOT - commercial license forms, you will need to click on hyperlink or go to DOT website http://www.dol.wa.gov/driverslicense/cdl.html   and fill in the interactive form, print and bring in for your scheduled appointment.

Records Transfer/Request From SVC Form - download this form and it can be used to request that your records from our clinic be sent  to another facility - This form may be mailed or faxed (253-537-7650) to our clinic .

Records Transfer/Request To SVC Form - download this form and it can be used to request that your records from another facility to be sent to our clinic. - This form may be mailed or faxed to the facility that has your records.

HIPAA Policy Guidelines Please review our HIPAA Policy Guidelines by clicking on this link.

My Med Schedule is a site where you can enter your medications and how you take them, then print out a reminder list. You can even have the web site e-mail or text you reminders to take your medication. Great free resource for those with complex medication schedules. Also great to use as a print out for your doctor or caregiver.

 

Get Adobe ReaderAdobe Acrobat Reader may be obtained free and is used by your browser to render the forms and brochures on this page.

 

 

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