Patient Forms

Below you’ll find forms that may be applicable to your primary or specialty care appointment or procedure. Complete and return them as requested by your care team before your UW Medicine hospital or clinic visit.

General UW Medicine

New patient registration form

Primary Care

Medicare Wellness Visit Health Risk Assessment

Medication history (new and established patients)
New patient health questionnaire (adults)
New patient health questionnaire (pediatric)
Prenatal history (if starting pregnancy care)
Preparing for Your visit (new and established patients)

Primary Care

Permission to Treat a Minor Without a Parent/Guardian Present

Telehealth Visit Instructions

Specialty care

New patient history form

Sterilization consent

Dermatology intake form

UW Psychiatry Patient Documents for Telemedicine Visits

New Patient Forms – Outpatient Psychiatry Clinic
Provided are links to forms for patients who are seeing a provider at the UW Outpatient Psychiatry Clinic. Please complete these forms and have them handy to review with your provider.

Telehealth Patient Info Sheet and Zoom User Guide
Provided are links to the forms for you to review prior to your initial appointment.

Questionnaires
Provided are links to the forms that you may need for your appointment. Please complete these forms and have them handy to discuss with your provider.

Safety Plan Template

Outpatient MRI screening | Arabic | Chinese | Farsi | Japanese | Korean | Russian | Somali | Spanish | Tigrinya | Vietnamese
CT contrast injection patient questionnaire | Arabic | Chinese | Japanese | Korean | Russian | Somali | Spanish | Tigrinya | Vietnamese
Cardiac perfusion scan questionnaire

Sleep Clinic Patient Questionnaire

Advanced Manual Therapy and Sports Rehabilitation Clinic

Questionnaire - Outpatient Physical Therapy

For Valley Medical Center patient forms, please visit the VMC website.

General UW Medicine

Advance directive forms

Medical records and authorization forms

New patient registration form

Primary Care

Condition-related forms

Medicare forms

New patient forms

Pediatric Well Child Visit forms

Primary Care

Permission forms

Sports physical forms

Telehealth visit instructions

Specialty care

Autism care forms

Arthritis clinic forms

Anesthesia, procedure and surgery forms

Dermatology forms

Hand, foot and ankle forms

Heart and cardiology forms

Infertility and reproductive medicine forms

Kidney transplant forms

Memory and brain wellness clinic forms

Psychiatry

UW Psychiatry Patient Documents for Telemedicine Visits

Radiology imaging test forms

Sleep care forms

Sports medicine, orthopedic, and physical therapy forms

Weight loss management forms

Women’s health forms

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