BELLEVUE SPINE SPECIALIST
 
13033 Bel Red Rd Suite 120, Bellevue, WA 98005 Phone: (425) 452-0101
Fax: (425) 452-0303
 










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New Patients

REGISTRATION AND HISTORY INFORMATION

For your convenience, we provide our Patient Registration and Patient History Forms here for you to print and complete at home as best as you can. Please bring the completed forms with you to your visit along with your insurance card.


RELEASE HEALTH CARE INFORMATION FORM


NOTICE OF PRIVACY PRACTICES

In compliance with a federal regulation Known as the "HIPAA Privacy Rule" we are providing you with our Privacy Rule. You may request a copy from our office or you may view and print the information by downloading it from the link below:
Download Privacy Policy
Download Financial Policy

Note: The downloadable files above are in PDF format. If you do not have AdobeĀ® ReaderĀ® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.