In order to provide the best medical care possible and optimize your time with the provider; please complete all the registration paperwork prior to your visit.

REGISTRATION FORMS: 

Link for Patient Registration Forms

  • Email forms to: contactus@dlcnw.com
  • Write “NEW PATIENT” in subject line.
  • If unable to email bring completed forms to your visit.
  • Bring list of all current medications or the bottles in a zip-lock bag.
  • In order to bill your insurance you must provide your insurance card(s) and photo ID at the time of visit.
  • Contact your insurance to verify if they require a referral from your primary care provider prior to seeing a specialist. Most common: Kaiser Permanente and Soundpath.
  • Co-pay is due at the time of visit.

RELEASE OF MEDICAL RECORDS:

Link to Authorization to Release Medical Records