Patient Forms

For your convenience, we have made commonly used patient registration forms available for printing. Please bring completed forms to your first visit. We ask that you come twenty minutes prior to your first appointment time to allow for data entry. Feel free to come earlier if you have any questions about the forms.

Patient forms

 

*Please print all 5 forms for Registration*

 

Patient Registration Form


Medical History Forms

 

Financial Policy

 

Referring Information Form

 

Accident, Incident, Injury Report

 

Complete only if scheduled to see a hand therapist

 

Hand Therapy Form

 

Hand Therapy - Medicare Coverage Information

 

 

Release of Records

 

Authorization to Release Healthcare Information - Records are typically sent out within one week from receipt of signed release.

 

Payment Portal - Sign up for e-Statement and/or view previous statements and payments using this portal: https://mymedicalbill.connectiq.net/seattlehand/.

schedule an Appoinment

206.292.6252 or 800.888.6252