Patient Forms

Selkirk Neurology, PLLC is committed to providing quality and comprehensive healthcare while ensuring the procurement and protection of your personal information is convenient and compliant.

Patient forms are required for intake and continuity of care and may include a comprehensive health history, an authorization to contact form and our financial policy outlining patient payment responsibility for all clinic services.

New Patient  Forms

You may receive new patient forms through the post if time allows after we schedule your appointment.  Please complete these and bring to your visit.

You may also access these documents to print at your convenience or for online submission to assist us in expediting your check-in process.

Questions? Call Us at 509-473-0885

Paper Submission

Click the below links to access the form(s) you need to print. Medical records may be released to Selkirk clinic by Provider to Provider request. 

Patients may REQUEST outside provider records be sent using RECORDS to SELKIRK

 

 

and REQUEST their SELKIRK records be shared with others

Online Submission

Click the below links to to be directed to HelloSign.  HIPPA compliant 3rd party eSignature partner

HelloSign Logo
 

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