Patient Forms
Intake, consent, and release forms.
Complete forms before your first visit to save time. Return them by secure message through the Patient Hub, by fax, or hand delivered.
How to return completed forms
Three secure ways to send them back.
Please do not email completed forms from a personal email address — email is not a secure channel for health information. Once forms are received, we’ll finish scheduling your appointment.
Secure message (preferred)
Send through the Patient Hub. This is our HIPAA-secure Spruce inbox — the safest way to send anything with your health information.
Fax
Fax to (509) 331-5080. Please include a cover page with your name and date of birth.
Hand delivered
Drop off at 7015 W. Deschutes Ave, Ste A, Kennewick, WA 99336. Office hours: Monday–Thursday, 9am–5pm PT.
New patients
Intake & consent forms — Required
New patients complete intake and consent forms through our Patient Hub before the first visit. This lets us prepare properly and gives you more time with the provider.
New Patient Intake & Consent
Complete online through the Patient Hub. Includes health history, current medications, prior treatments, informed consent, and financial policy acknowledgment.
Acknowledgment of Non-Insurance Coverage
Confirms your understanding that we’re a direct-pay practice, that certain services aren’t insurance-billable, and that you may request a superbill for possible reimbursement.
Records & releases
Release form — Optional
Use this form to have your records sent from a previous provider to us, or to release records from our office to another provider or party. HIPAA-compliant under 45 CFR §164.508.
Authorization for Release of Medical Records
One form handles both directions — TCPH releasing your records out, or requesting records in from another provider. Includes optional sensitive-info categories with separate opt-in.
Prefer we handle it?
Send us a secure message through the Patient Hub with the name, phone, and fax of your previous provider. We’ll send the release request for you — no form to fill.
Service-specific consent
Only when requested for the service
These are completed before specific treatments. You’ll receive them by secure message when they apply to your care, but they’re available here in advance if you’d like to review them.
Infrared Sauna Waiver
Informed consent and safety acknowledgment for infrared sauna sessions. Please review contraindications and complete before your first session.
Superbill (blank template)
For your reference — an itemized receipt template with fields for patient information, diagnoses, and services rendered. We complete this for you after each visit if requested.
Questions
Frequently asked
Can I email completed forms to [email protected]?
We ask that you send anything containing health information through the Patient Hub instead. Even though our clinic inbox is on Proton (encrypted end-to-end when both sides use it), most patient email accounts aren’t — and the outbound leg is unencrypted. The Patient Hub is the safest channel.
Do I have to sign a records release to be seen?
No. The release form is optional. It’s only needed if you want records transferred to or from another provider. If you don’t need records shared, you can skip it entirely.
How long is the records release valid?
One year from the date you sign, unless you specify a different expiration date or event on the form. You can revoke it at any time by giving us written notice.
Can I bring the forms with me to my first visit?
Yes — that works too. Just plan to arrive a few minutes early so we have time to review them before your appointment starts.
I have sensitive information in my records (mental health, substance use, HIV, genetic, STI). Is it protected differently?
Yes. Those categories require separate authorization — the release form has a dedicated section with individual checkboxes so you can choose which of those, if any, to include. Nothing in those categories will be released unless you specifically opt in.