Emerald City
Medical Arts

16 Roy Street
Seattle, WA 98109
Phone: 206.281.1616
Fax: 206.282.7371
Contact via Email


Family Physicians providing quality healthcare on Queen Anne since 2001


Accepting New Patients!
Schedule an Appointment


In The News...

KING 5 News

KUOW

The Coleman Institute

 

Patient Forms

New Patient Forms

New Patient Forms

If you are a new patient and would like to save time during your first visit, please feel free to print out the following forms, fill them out prior to your appointment and bring them with you. Otherwise, you will be provided with copies of these forms to fill out when you arrive.

New patient forms
Health History form
Patient Agreement form

Records Release Forms

If you would like to have your medical records released TO Emerald City Medical Arts, please use this form.

If you would like to have your medical records released FROM Emerald City Medical Arts, please use this form.

Incident Reports

Incident Reports Explained
Incident Questionaire General

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All Emerald City Medical Arts forms are in PDF format and you will need Adobe Reader to access them if it is not already installed on your computer. You may get the Adobe Reader from the link below if you do not already have it installed.

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