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Forms / Directions

Naturopathic Medicine with Dr. Fitzpatrick

Sign upForms include: Patient Information, Notice of Privacy Practices, Acknowledgement of Receipt of Privacy Practices, Confidential Health History Questionnaire, Metabolic Assessment Form, Consent for Treatment, Patient Financial Agreement, Health Questionnaire (NTAF)


Psychotherapy with Dr. Fitzpatrick

Forms include: Patient Information, Notice of Privacy Practices, Acknowledgement of Receipt of Privacy Practices, Preliminary Psychotherapy/Hypnotherapy Intake Form, WA Psychology Information and Agreement

Medical Appointments with Dr. Smoots

Forms include: Patient Information, Health Questionnaire, Informed Consent, Financial Agreement, Acknowledgement of Receipt of Privacy Practices, Notice of Privacy Practices

 

Parking Directions
We are located in the North Seattle Professional Center. Though our address is on 3rd Avenue NE, the building spans the block between 3rd and 4th Avenues NE. Patient parking is accessed from 4th Avenue NE. If you enter the building from the patient parking lot, our office will be the second door on your left.

Parking sign

Driving Directions
Click on the map for directions

Map


Emerald Center for Integrative Medicine
9730 Third Avenue N.E., Suite 202, Seattle, WA 98115 - 206-525-5576 - Fax 206-525-5776
info@theemeraldcenter.com


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