Patient Forms

• Financial Form
• Patient Registration Form
• Patient History Form
• Notice of Privacy Practices Form
• Photographic Consent Form
• Consent to Treat a Minor Form

Click HERE to print out our survey and let us know how we're doing.

Please bring it with you into the clinic on your next visit or mail to:

Victor R. Michalak, M.D.
NE Gilman Professional Ctr.
295 NE Gilman Blvd. Ste. 101
Issaquah, WA 98027