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New patient forms

We take great pride in treating our patients in a manner that is not only caring, compassionate and based on the best medical practices, but also personal, friendly, timely, and efficient. To help us make your visit go as smoothly as possible, please review the information listed below and come prepared.

Please provide us with the following:

  • Insurance card(s)
  • Referral forms from your primary care provider (if required by your insurance plan)
  • X-rays, lab results, and previous records relating to the condition for which you are seeing us
  • Your personal medical history, including a list of medications and allergies

We are contracted with the following insurance companies:

If you don’t see your insurance listed call us at 360-714-3400 to see if we are participating. Some insurances do require referrals, if you are unsure feel free to contact us and we will let you know.

  • Medicare*
  • Kaiser
  • Kaiser Medicare Advantage
  • Regence Commercial
  • Regence Medicare Advantage
  • First Choice
  • Molina
  • DSHS
  • Cigna
  • Aetna Commercial
  • Aetna Medicare Advantage
  • First Health
  • Premera Commercial
  • Premera Medicare Advantage
  • Lifewise
  • Humana Commercial
  • Humana Medicare Advantage
  • Humana Medicare Advantage
  • TriWest/VA Choice

*If you have a Medicare Advantage plan, it is very important that you follow the rules set by your insurance carrier. Please refer to your benefits booklet for information about seeing a specialist. You may need a referral from your primary care doctor or a waiver from your insurance plan before your visit.

The following Medicare Advantage plans require referrals or exceptions from the plan in order to receive out-of-network services:

  1. Evercare
  2. Secure Horizons
  3. AARP Medicare Complete

Please call your insurance company prior to scheduling your appointment.

New Patient (Male)


AUA Symptom Score Sheet
Privacy Practices
 (Read Only)

Financial Policy

Consent to Leave Messages

Male HEalth History

New Patient (Female)

Patient Health Questionnaire

Female Urology Questionnaire
Privacy Practices
(Read Only)

Financial Policy

Consent to Leave Messages

Medical Records Release

Release our records to another provider
Request record from another provider