Ohana Wellness Center - Bellevue, WA

Leah McNeill, ND

NEW PATIENT FORMS

*Print, complete, sign and date the appropriate forms.
Then bring with you for your first visit along with your insurance card and driver's license.

Note: The Patient Privacy Policy is provided in this link HIPPA Privacy Policy.
It is provided for your review online or to print if you wish to retain a hard copy for your files.
You do not need to bring with you.

We request you print these forms SINGLE-SIDED only.
Please do NOT print double-sided.

Intake and health history....[these forms are for patients age 14 and older]

Pediatric intake and health history....[these forms are for patients UNDER age 14]