PATIENT FORMS
NEW PATIENTS
If you are a new patient to the clinic, please print and fill out the following forms, and bring them with you to your first appointment:
- New Patient Registration
- Adult Medical History
- Pediatric Medical History
- Notice of Privacy Practices
WELL CHILD EXAMS
If you are bringing in your child for a well child exam, please print and fill out the following forms, and bring them with you to your child's appointment. Please bring your child's prior immunization record with you.
WELL ADULT EXAMS
If you are coming in for a well adult exam, make a selection below, print and fill out the form, and bring with you to your appointment. Please also bring a list of medications you are currently taking, or bring all your medications with you to the appointment.
- Female Well Adult Exam (Dr. Mahoney or Dr. Bishop)
- Female Well Adult Exam (Dr. Wingren)
- Male Well Adult Exam
BONE DENSITY STUDY PARTICIPANTS
If you are having a Bone Density Study, please print and fill out this form and bring it with you to the appointment. A Physician order is required before this study can be performed.
CHANGE OF ADDRESS / RECORDS RELEASE REQUEST
If your address or other information has changed, or if you are requesting a copy of your records, choose the appropriate form to print out:
You may fax the form(s) to:
(360) 378-3655, ATTN: Lead ReceptionistOr mail to:
Inter Island Medical Center
ATTN: Lead Receptionist
550 Spring Street
Friday Harbor, WA 98250