Service Update: As of Mon 8/17, Primary Care appointments with Excelsior Family Medicine will be in-person at 3754 Indian Trail. All other services remain virtual or offsite until further notice.

PAY MY BILL
DONATE
Call us: (509) 559-3100
Patient Packets and Consent Forms

Primary Requests and Forms

Request Services

Request Services

Sliding Scale Request

Financial Assistance Form

Records Request Form

Records Request Form

Release of Information

Release of Information Form

Consent Forms

Group Telehealth Consent Form

Consent Form

General Release of Liability Form

Liability Form

Telehealth Consent Form

Telehealth Form

Program Forms

New Patient/Consent to Treatment Service Forms

Consent To Treatment Form

BRS Service Forms

BRS Form

EFM Behavioral Health Service Forms

EFM-W Form

IIP Service Forms

IIP Form

WISe Service Forms

Go To Form

Audio, Video, Photo Release Waiver

Go To Form

Demographic Form

Go To Form

Video Gaming Release

Go To Form