Patient Forms

At your first appointment, you will need a completed patient information and health history form. It is helpful if you complete these in advance, and bring along copies of previous tests, lab results, and the names of medications or natural supplements you are currently taking.

All patients must complete the following form and bring them to their first appointment. 

Other important forms:

Service Specific Forms

 Nutrition Assessment Form

DCWC Intake Form

Environmental Medicine Health Questionnaire 

If you are scheduled for a Mind Body visit, please review this Welcome Letter and fill out these Mind Body Intake forms. 

If your physician recommends it, please fill out the Digestive Questionnaire Form

If you are requesting your medical records be released to or from our clinic, please fill out the corresponding release form. 

A parent/legal guardian must attend a minor’s first visit at Bastyr Center for Natural Health. For parents or legal guardians who cannot be present for subsequent visits, please fill out this form: Permission to Treat a Minor Without a Parent/Guardian Present. 

To sign up for access to your child's MyChart record (children 11 and younger), please complete this form:  Parental/Guardian Proxy Access to a Child's MyChart Record and email to patientcontact@bastyr.edu. Include Photo ID which is required to activate proxy. Please note that your child’s chart will be accessed through your MyChart record.  

For any patient 12 and older that would like a parent or a legal guardian to access their MyChart account, please complete this form: Teen-Adult Guardian Proxy Access to MyChart and email to patientcontact@bastyr.edu.