PRESCRIPTION REFILLS

PLEASE CALL YOUR PHARMACY TO ORDER REFILLS AND ALLOW 48 HOURS.

www.northislandmedical.org

PATIENT FORMS

Please complete these forms and bring them with you to your first appointment:

Patient Registration Form

Health History

Medication Record

Authorization to Treat Minor

Privacy Practices    (See HIPAA links below)

HIPAA:

Health Insurance Portability & Accountability Act of 1966

Privacy, Security and Electronic Health Records

Your Health Information Privacy Rights

INSURANCE WE ACCEPT

  • Aetna
  • Blue Cross/Blue Shield
  • Cigna
  • First Choice Health
  • Group Health Cooperative
  • L & I (Labor & Industries)
  • Medicare
  • Regence
  • United Health Care
  • Tricare


If you do not see a specific insurance provider, please call our office directly as we frequently make additions to this list.

patient forms and resources