Forms

New patient forms:

Before we can schedule your initial consultation, we need you to fill out the Insurance Verification form and the Comprehensive Patient History form.

You may return all forms by email, fax or mail:

• Email: Info@c4wls.com
• Fax: 253-815-7708
• 34509 9th Avenue S, Suite 103
  Federal Way, WA 98003

Insurance Verification Form

Please complete this form so we can contact  your insurance company to verify  benefits for bariatric surgery and office visits.

• Online Form
• Printable Version

Comprehensive Patient History Packet

The information you provide is used to create your chart in our secure medical records system and is reviewed before your consultation

• Comprehensive Patient History Fillable Form

Other Forms:

Patient Office Visit Form

• Print Office Visit Form
• Medication List Form
• Authorization for Release of Medical Record Information Form
• Notice of Privacy Practices