New Patients Provider Referrals Insurance
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, continuity of care and insurance processing.
It may include a request for comprehensive health history data, an authorization to contact form and our financial policy outlining patient payment responsibility for all clinic services.
Referrals are required along with requested information to best determine how our clinic and Providers may serve your needs. We require the following NEW PATIENT REFERRAL/CONSULT document be completed and sent along with all requests for consult or referrals.
Call 509-473-0885 with any questions
New Patient Paperwork
You will receive new patient paperwork through the post if time allows as we schedule your appointment.
Please complete these and bring to your visit.
You may also access these documents HERE to print at your convenience to assist us in expediting your check-in process.
Questions? Call Us at 509-473-0885
Medical Release of Information
Click below to access form(s) to request
RELEASE OF MEDICAL RECORDS either
TO or FROM Selkirk Neurology and Clinic
Secure Online Submission
Click below to to be directed our HIPPA compliant 3rd party eSignature partner to request forms for direct submission online
Please Note: Emails for document signing will be from HelloSign and may post to a secondary use folder
i.e. Other or Spam
Call our Office if you need assistance
509-473-0885
Selkirk Neurology Currently Accepts the Following Insurances
Premera Blue Cross and Blue Cross Blue Shield Plans
Kaiser Commercial, Medicare Advantage, & Supplement Plans
United Healthcare Commercial, Medicare Advantage, & Supplement Plans
Cigna/GreatWest Healthcare
Aetna
First Choice Health Network
Medicare
Tricare-West
Ameriben Commercial
CHPW Medicare Advantage
GEHA
EBMS
HMA
Lifewise
Medicare Railroad Retirement
Premera Medicare Advantage
UMR
Pacific Source Commercial & Medicare Advantage
Most Supplement Plans