Lifespring Cancer
Treatment Center
New Patients

Patient Intake Forms

Please fill out the packet of forms and fax them to us at 1 (206) 686-1268 as soon as possible. The most important form is the Authorization to Release Health Care Information. We will use this to obtain your medical records. Once this is completed we can schedule an appointment at your earliest convenience. If you have any questions or concerns, please give us a call at 1 (206) 686-1266. Thank you!

Download Forms

This packet contains:

Patient Information Form
Basic information and contact methods
Patient Health Questionnaire
Treatment history, family medical background, and medications
Authorization to Release Health Care Information
Provides us access to patient information from other healthcare providers
Lifespring Acknowledgement
Etiquette and standard clinic procedures
Notice of Privacy Practices
Acknowledgement of privacy practices and patient privacy rights
Patient Consent for Research and Publication Form
Consent to include your anonymized treatment information and results for research