To save you time, we have several forms available for you to download, print and fill out before you arrive at the clinic. These forms are available at the clinic as well.
New Patient
- Intake Form (Click Here)
- HIPAA Notice of Privacy Practices (Click Here)
- HIPPA OPT-OUT (Click Here)
- Authorization to Release Healthcare Information (Click Here)
- Puget Sound Work Injury Clinic Policy (Click Here)
- Cancellation and No-Show Policy (Click Here)
- Patient Health Questionnaire (Click Here)
Reopening Claim
- Application to Reopen Claim (Click Here)
- Intake Form (Click Here)
- HIPAA Notice of Privacy Practices (Click Here)
- HIPPA OPT-OUT (Click Here)
- Authorization to Release Healthcare Information (Click Here)
- Puget Sound Work Injury Clinic Policy (Click Here)
- Cancellation and No-Show Policy (Click Here)
- Patient Health Questionnaire (Click Here)
Transfer of Care
- Transfer of Care (Click Here)
- Intake Form (Click Here)
- HIPAA Notice of Privacy Practices (Click Here)
- HIPPA OPT-OUT (Click Here)
- Authorization to Release Healthcare Information (Click Here)
- Puget Sound Work Injury Clinic Policy (Click Here)
- Cancellation and No-Show Policy (Click Here)
- Patient Health Questionnaire (Click Here)
NOTE: You will need a PDF Reader such as Adobe Acrobat Reader to open PDF documents. Also you will need access to a printer to print the forms out.
Puget Sound Work Injury Clinic 