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At Overlake Family Medicine our goal is to provide individuals and families
with comprehensive medical care in a personal setting.

Forms

We ask new patients to complete a set of forms for their first appointment. It takes approximately 20 minutes to complete all the necessary paperwork. In order to facilitate completion of the forms you may download them here, fill them out at your convenience, and bring them to the appointment with you.

If you are unable to do this, we ask that you arrive about 20 minutes early for your first appointment to complete this paperwork. Please bring your medical insurance card and current medications with you as well.  If the appointment is for your child, please bring his or her immunization record.

The following forms are PDF files, and may be downloaded to your computer and printed.

NOTE: These forms cannot be completed online. Please print them out and bring the paper copy with you to the appointment.

Patient Registration Form
This form contains important billing and insurance information. Please complete and bring this to your appointment if you are a new patient, or if it has been more than three years since your last visit.

HIPAA Forms
These forms are required by law, and allow us to accommodate your privacy preferences. Please complete and bring these to your appointment if you have not completed them previously, or are a new patient.

Financial Policy and Consent Form
This form details our billing policy. Your signature is necessary on this form in order for you to be seen and to allow us to bill your insurance.

New Patient Health History Form
If you are an ADULT new patient to our clinic (age 18 years and older), please complete and bring this form.

Pediatric Health History Form
If you are a PEDIATRIC new patient (under the age of 18 years), please complete this form and bring it to your appointment.

Overlake Family Medicine Notice of Privacy Practices

Sports Physical Checklist (coming soon)
If you have an appointment for a sports physical, please bring your school's sports physical form to your appointment. If it does not include this checklist, please complete page one of this form and bring it with you as well.

Thank you for taking the time to complete these forms thoroughly. In some cases, certain forms may need to be completed upon your arrival.

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Overlake Family Medicine
3080 148th Avenue SE, Suite 115 • Bellevue, WA 98007
ph. 425-378-8190 • fax: 425-649-1523