Patient Paperwork & Forms
Complete the necessary paperwork for you next appointment ahead of time. Download. Print. Complete. Return the forms to our office by mail, fax, or bring them with you on your next visit.
Once completed, please return the records request form to our office or mail to this address:
Palouse Medical
825 SE Bishop Blvd. Suite #200
Pullman, WA. 99163
Fax Number: 509-334-9247
Patient Profile Form 1
This provides us contact information and patient demographics.
Personal Health History Form 2
This form is completed by new patients and those (ages 16 and older) who are returning for yearly physical examination.
Flex Spending: OTC Reimbursement Request OTC Reimbursement Form
This is Palouse Medical’s general form for patients to complete to receive reimbursement for Over-The-Counter (OTC) medical expenses from flex spending plans. Check with your Flex Spending plan to verify that this form will work, as Palouse Medical can not guarantee that your Flex Spending plan will accept this generic form.
Below are two links that will help keep your medical records current and managed. Please choose the appropriate form and click on the attached link. This will open a window with a PDF file containing the authorization you need. Medical Records Release Form This form authorizes us to release your medical records or health information to a designated individual or an external health care provider. Medical Records Request Form This form authorizes us to request your medical records or health information.
Important Notice:
You may choose to fax, mail or bring this document in personally; however, we must obtain the signature of the individual(s)/legal guardian of the medical records in question BEFORE we can process the request. Thank you for understanding and your cooperation.Medical Records Authorizations
Our Release Form
Our Request Form
