Form Download Page

This page is designed to provide new clients with the 6 forms needed for your first visit to my office. The forms provided are: 

1. Patient Information Form 

2. Symptom Checklist 

3. Issue Identification & Treatment Objectives Form 

4. Policy Form 

5. Confidentiality Form

6. Washington Notice Form 

Download buttons are provided below for each of these 6 forms. PDF files can be viewed before downloading. 

If you have any questions, please call or email me. My office hours are 12pm to 9pm Monday thru Thursday. The best time to reach me in person is about 10 minutes to the hour 425  778-4174. You can also email me at Drbfmoss@ix.netcom.com. 

NOTE:  Email should not be used to communicate information that is urgent.  By choosing to communicate with a health professional via email, you acknowledge that even when all reasonable security measures are employed, email is not guaranteed as entirely secure or private.  If you choose to communicate via email, this implies your agreement to accept the risks of email communication.  Emails sent are treated as health records.