For Kenmore Primary Care Patients
We value your time and want your appointments to go as smoothly as possible.
Below, you will find information and all of the items necessary to streamline the registration process and help us provide you with a great and timely experience.
If you have any questions, please call your primary care clinic.
For New Patients
Patient Forms
If you are new to our practice or have not been seen within the last year, please take time to complete these forms and bring them to your appointment.
Everyone should complete:
Also read and complete the form(s) appropriate for your visit:
Adult Visit - preventive health exam/annual physician
Adult Visit - all other
Adult Visit - Medicare
Child Visit - well child check
Child Visit - all other
- Pediatric Health Questionnaire
- Patients under 18 years of age should be accompanied by a parent or legal guardian, otherwise you will need to complete the Consent to Treat a Minor form
Check out the billing section below for other important information.
Your Medications
If possible, please bring all of your medications, vitamins and supplements in their original container(s) to your first appointment.
Some medications, such as those for chronic pain or anxiety, may not be filled during your first visit in accordance with our controlled-substance policy.
Once you’ve established care with us, you’ll request refills directly from your pharmacy. To make sure you don’t run low on your medications, please plan for a 48- to 72-hour processing time.
For Returning Patients
Please read and complete the appropriate form and bring to your appointment.
Returning patients
Returning Medicare patients
Useful Information
Need your provider to complete a form?
If you need your provider to complete a form (return to work form, approval to join a gym, etc.), you can upload the form to us using the My Navigator patient portal.
Just follow these easy-to-use instructions.
Insurance
In order to make sure you receive the health benefits to which you’re entitled, please present your ID and insurance card at every visit.
We’ll accept co-payments when you check in.
Check our list of accepted insurance plans
Billing
These links will provide details about the billing process so you can accurately understand your coverage.
Click here to request a personalized estimate for your out-of-pocket cost before you receive treatment.
For questions about a billing statement you've received, check our billing information page.
Need Assistance Paying for Healthcare?
EvergreenHealth's Community Health Access program partners with many community organizations to assist low income and uninsured residents of our service area who face barriers in accessing affordable and quality health and social services.
Click here for more information.
Request a Copy of Your Medical Record
Click to request a copy of your medical record.
DOT Medical Exam Certificate
Please review this document prior to your appointment.
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Be Your Healthiest Best
Helpful Links
