Patient Forms

At your first appointment at Bastyr Center, you will be asked to complete a patient information form and health history. It is helpful if you bring along copies of previous tests, lab results and the names of any medications or natural supplements you are currently taking. You can also save time by bringing the completed forms with you on your first visit. (Download free Adobe Reader software.) Download and print the PDF documents below. Then bring the completed paperwork with you to your first office call:

Additional Forms

A parent/legal guardian must attend a minor’s first visit with Bastyr Center for Natural Health. For parents or legal guardians who cannot be present for subsequent visits, please fill out this form: Permission to Treat a Minor Without a Parent/Guardian Present.

To sign up for access to your child's MyChart record (children 11 and younger), please complete this form:  Parental/Guardian Proxy Access to a Child's MyChart Record and email to [email protected]. Include Photo ID which is required to activate proxy. Please note that your child’s chart will be accessed through your MyChart record. 

For any patient 12 and older that would like a parent or a legal guardian to access their MyChart account, please complete this form: Teen-Adult Guardian Proxy Access to MyChart and email to [email protected].