For Internal Medicine + Primary Care Patients

Please download, print and complete these forms...then bring them with you to your appointment.


Medicare Patients

Please download and complete these forms, and bring them with you to your first appointment.


Release of Information from another Clinic

If you are coming to EvergreenHealth Internal Medicine + Primary Care from another clinic, this form will instruct your former provider to release your Personal Health Information to us. 

Download and complete the form, then fax or mail it to your former clinic.


Release of Information to another Clinic

If you are moving to a new clinic, this form will authorize us to release your Personal Health Information to your new provider.

Download and complete the form, then return to EvergreenHealth Internal Medicine + Primary Care.


Request a Copy of Your Medical Record