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

 Print

 Complete

 Fax 509-793-0883

 Attn: Consult Referrals

New Patient Paperwork

Doctor with Computer

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