Fidalgo Island Walk-In Clinic
1500 Commercial Avenue
Anacortes, WA 98221
(360) 299-2650
Quality, Affordable Healthcare On Your Schedule.
on your schedule.
Forms
In order to serve you better, the following forms are available for you to
print outand complete at home to have ready when you present at the
clinic. If possible, please complete the forms in black ink, because they
will scan more clearly into your medical chart.
1. New Patient Forms (on first visit only)
2. Exam Check-In Forms (for each visit)
3. Sports Physical Forms: Page 1 Page 2
4. Authorization for Administration of Medication at School Form
5. DOT Physical Forms
6. Merchant Mariner Physical Forms
7. Release of Information Request Forms
8. Walk-In Weight Loss Form #1
9. Walk-In Weight Loss Form #2
print outand complete at home to have ready when you present at the
clinic. If possible, please complete the forms in black ink, because they
will scan more clearly into your medical chart.
1. New Patient Forms (on first visit only)
2. Exam Check-In Forms (for each visit)
3. Sports Physical Forms: Page 1 Page 2
4. Authorization for Administration of Medication at School Form
5. DOT Physical Forms
6. Merchant Mariner Physical Forms
7. Release of Information Request Forms
8. Walk-In Weight Loss Form #1
9. Walk-In Weight Loss Form #2
