Integrative Medicine Associates  Combining the best in natural and conventional medicine for over 25 years
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ALERT for patients on Hormone Replacement Therapy:

Please be aware that as of August 1, 2010, all female patients that elect to have their Hormone Replacement Therapy prescribed through our office will be required to maintain their annual exams (pelvic/pap, breast exam, etc.) and mammograms directly through our office.

New Patient Forms for Download
please print and complete
Please print and complete.
There are three separate forms relative to health issues, plus several forms in the packet for patient releases and our Integrative Care Program Annual Enrollment Agreement:

Health History

Health Screen

Patient Information

Notice of Privacy Practices

Authorization to Release Health Care Information

Medicare and DSHS Private Contract Acknowledgements

Office Policy

Patient Consent for Telemedicine Evaluation, Email and Phone Messages

Integrative Care Program Annual Enrollment Agreement - Individuals

Integrative Care Program Annual Enrollment Agreement - Families

Please bring all of the above, printed and signed, with you to your first office visit.


VERY IMPORTANT


If possible, please bring in one year's worth of information that may be pertinent to your office visit.

This would include a list of your current medications and supplements, as well as any laboratory results and medical records that may be available.

This information will assist the providers in your evaluation and management and help save time and money.

THANK YOU VERY MUCH!


Office Police for New Patients Wishing to reserve a new patient
slot: New patients are asked to pay a $75 new patient fee for reserving a new patient slot at our office.

These forms require the free Acrobat Reader to view and print.


You can download this application here



You may also wish to print this FAQ sheet about the IMA Integrative Care Patient Program. This is not required and you do not need to bring this to your office visit. If you choose to view online instead, the FAQs are here.

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Your life is not your master. It is your child.

Emmanuel