Click a link below to download and print a PDF form.
New Patient Forms
Please print and read the New Patient packet for complete details and information regarding your New Patient appointment- including a list of medications to stop prior to your appointment. Please fill out the General Patient Information, Allergy History, Consent and Cancellation Policy forms and bring them with you to your appointment.
New Patient Packet
School Forms
Please complete the lower portion of the applicable form(s) and fax to Att: Nurse Triage at the office where you see the doctor. Click here for a List of Locations with our fax numbers.
- Medications at School- Albuterol
- Medications at School- Benadryl
- Medications at School- Other
- Anaphylaxis Action Plan
Immunotherapy Form
If you have checked with your insurance and have now decided to either start a Program of shots or want to request a renewal of your antigen, fill out this form and fax it to the Seattle office at: 206-523-0724 Att: Antigen Department.
Medical Record Form
Please complete and fax to the Seattle office at: 206-523-0724 Att: Medical Records Department.
EZ Pay Form
This will allow us to automatically charge your credit card for regular shot co-pays and other patient responsibility charges that you may authorize. Fill out the form and fax it to: 206-527-0535. You may also scan and send by email to: ptaccounts@nwasthma.com
