New Patient Forms

Please print these forms, fill them out, and bring them with you to your first appointment.

Adult – New Patient Intake Form

Pediatric (6 – 12 years old) – New Patient Intake Form – Being Redesigned, Available Soon!

Pediatric (birth – 5 years old) – New Patient Intake Form

Optional:

Diet Diary – Clinical Nutrition Evaluation

Dr. Barry Wheeler
Naturopathic Doctor

Skyline Tower
10900 Northeast 4th Street
Suite 2300
Bellevue, WA 98004 (map)
(425) 516-5500

Hours: 8am – 5pm, M – F

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