Required Patient Information:
All Patients must have up to date personal information on file with the clinic.
New Patients
Please print the appropriate forms below. Fill them in, and bring them to your first visit. Filling them out in advance allows you to carefully consider the questions, provide complete answers, and it saves valuable time during the appointment. You may also bring any supplemental information that you feel is important.
Established Patients
Please let us know if there are any changes to your personal, insurance, or health information. Print the appropriate forms below and fill in the updated information. Bring the form and any other related information to your next visit so we can update our records. This will allow us to provide the best care possible, and reduce errors in billing.
Forms:
- General Information and Health History (Required)
This form provides the basic history and insurance information we need to create your medical chart and begin offering services. Please make sure that you provide complete answers to each question. - Notice of Privacy Practices (Required)
When completed, this statement acknowledges that you have received a copy of our Privacy Statement. It also tells us how you want to be contacted for communication of lab results and other information. -
Release of Information (Optional)
When completed, this form authorizes us to release specific health information about you to others for special purposes. Use it only if you have a specific need to share your health information with others who don't normally have access to your health records (see Privacy Statement).
Our Patients Use Relay Health
What is Relay Health?
Relay Health provides secure on-line communication services for the healthcare industry. Our clinic makes Relay Health available for our established patients who wish to communicate via the Internet. With Relay Health you can request prescription refills, referrals, lab results, and more. You can also use Relay Health to schedule your next appointment. A special feature of Relay Health is the Web Visit that lets you consult with your medical provider and receive treatment via the internet for conditions that are safe to treat this way.
Our goal is to make it easier for you to handle routine communications on a schedule that meets your needs. The service is available through any standard Internet web browser, 24 hours a day. All you have to do is register on the Relay Health Web site. Requests submitted to our office via Relay Health will generally be handled during the next business day.
Web Visits
Web Visits are a special feature of Relay Health that let you contact your provider over the Internet to ask medical questions or seek treatment for routine medical issues that can be safely treated in this way. A Web Visit consists of an on-line interview where the questions are designed to provide the information your provider needs to diagnose your condition and recommend treatment. Web Visits are convenient to use, and only cost $25. Be aware though that most insurance plans do not cover web visits yet. We recommend that you understand your plan's coverage limitations before beginning a Web Visit
How do I use it?
- Visit the Relay Health Website. Their Patient Information page provides a clear description of the service.
- Take the Quick Tour to see what you can do with Relay Health.
- Use "Find Your Doctor" to search for Bonnie Sprague, Kirstin Curtis, or Renee Wilgress. You can also search for us by our zip code (98225). This will take you to your provider's home page.
- Register and Sign In
Limitations
Relay Health should never be used for urgent medical needs. Always call the office when response time is important.
Web Visits are not a substitute for most office visits. Most medical conditions still require you to be physically seen by your provider for proper diagnosis and care.