Patient Forms

Patient Forms

Please print, complete and bring the following three (3) forms with you to your initial appointment. If you also need to request medical records or lab results from your current provider, please complete the Medical Release form in the Existing Patients section below.

(Your current provider would be listed in Section 2, SVC would be listed in Section 3).

New Patient Information Form
Financial Policy Acknowledgement
HIPAA Acknowledgement
Initial Visit Payment Form
HIPAA ackn*

*For your information only, please read the following. No need to bring this to your appointment.

Existing Patients

If you need a copy of your SVC medical records for yourself or sent to another medical office, please complete the following form and return to us. Fax: (509) 290-6305 or email spokanevitality@gmail.com

(SVC would be listed in Section 2).

Medical Release
Payment Form