New Patient Forms - Chandler

Here are the forms you will need for your first appointment with Doug Chandler.    

What to do:
1)  The files are listed at the bottom of this page.  Start by looking at the 2nd column 
2)  Select each of these forms as they apply to your situation.  
3) Click "Download" to download the forms to your computer. (Choosing the 'view' option might not work)
4)  Open the forms. They are in Adobe Reader  (PDF) format.
5)  Complete and sign the forms.  Notes:  If the patient is between 13-17 years of age, we need signatures from the teenager and the parent/guardian. We can only provide services if the required forms are completed, signed and unaltered.
6)  Bring them in for your appointment.  

Thank you.
 
 Douglas Chandler
SelectionFile type iconFile nameDescriptionSizeRevisionTimeUser
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View Download
ALL EVERETT PATIENTS: General information, directions to my office.  For you use.  850k v. 2 Dec 20, 2018, 3:31 PM Douglas Chandler
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ALL MOUNT VERNON PATIENTS. Has general info about my office, and directions. For your use.  574k v. 2 Dec 20, 2018, 3:32 PM Douglas Chandler
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ALL PATIENTS. Print, complete, sign.  643k v. 2 Dec 20, 2018, 3:27 PM Douglas Chandler
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ADULTS - Please complete form.  395k v. 1 Apr 26, 2019, 5:26 PM Douglas Chandler
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UNDER 18 YRS OLD. Print, complete.  360k v. 2 Dec 20, 2018, 3:31 PM Douglas Chandler
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REQUIRED, ALL PATIENTS. Print out 2 copies. Complete, initial and sign 1 copy to bring in.  512k v. 2 Jan 2, 2019, 4:26 PM Douglas Chandler
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DOWNLOAD FOR YOUR OWN USE  696k v. 2 Dec 20, 2018, 3:26 PM Douglas Chandler
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REQUIRED OF ALL PATIENTS. Print, complete, sign.  136k v. 2 Dec 20, 2018, 3:28 PM Douglas Chandler
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ALL PATIENTS WITH INSURANCE. For your use.  271k v. 2 Feb 27, 2016, 2:52 PM Douglas Chandler