Request Your Appointment 1 Patient Information2 Appointment Setup3 ConfirmationYour Name* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Mobile Phone Number*This is only used to confirm your appointment.Last 4 of Social Security NumberThis will be used to verify your identity and give access to our secure online patient portal.Health InsuranceWe accept most insurance. Enter your insurance (optional)Please Select Your Health InsurancePlease note we do NOT accept Medicare or Medicaid.PremeraBlue Cross Blue ShieldRegenceUnited HealthcareAetnaLifewiseFirst ChoiceKaiser PermanentGroup IDMember IDAppointment Location*Seattle Clinic Hours: Mondays (8am to 11am), Wednesdays (8am to 2pm), Saturdays (8am to 10am)Kirkland Clinic Hours: Mondays (1pm to 3pm), Tuesdays (8am to 3pm), Thursdays (8am to 3pm), Fridays (8am to 3pm), Saturdays (Noon to 3pm)SeattleKirklandAppointment Date Requested* Appointment Date Requested* Appointment Time RequestedThe following appointment times are generally available but our staff will call you to confirm your appointment after your request has been submitted. 8:00AM 8:30AM 9:00AM 9:30AM 10:00AM 10:30AMAppointment Time RequestedThe following appointment times are generally available but our staff will call you to confirm your appointment after your request has been submitted. 8:00AM 8:30AM 9:00AM 9:30AMAppointment Time RequestedThe following appointment times are generally available but our staff will call you to confirm your appointment after your request has been submitted. 8:00AM 8:30AM 9:00AM 9:30AM 10:00AM 10:30AM 11:00AM 1:00PM 1:30PM 2:00PMAppointment Time RequestedThe following appointment times are generally available but our staff will call you to confirm your appointment after your request has been submitted. 1:00PM 1:30PM 2:00PMAppointment Time RequestedThe following appointment times are generally available but our staff will call you to confirm your appointment after your request has been submitted. 1:00PM 1:30PM 2:00PMAppointment Time RequestedThe following appointment times are generally available but our staff will call you to confirm your appointment after your request has been submitted. 1:00PM 1:30PM 2:00PMAppointment Time RequestedThe following appointment times are generally available but our staff will call you to confirm your appointment after your request has been submitted. 8:00AM 8:30AM 9:00AM 9:30AM 10:00AM 10:30AM 11:00AM 1:00PM 1:30PM 2:00PMAppointment Time RequestedThe following appointment times are generally available but our staff will call you to confirm your appointment after your request has been submitted. 8:00AM 8:30AM 9:00AM 9:30AM 10:00AM 10:30AM 11:00AM 1:00PM 1:30PM 2:00PMAppointment Time RequestedThe following appointment times are generally available but our staff will call you to confirm your appointment after your request has been submitted. 8:00AM 8:30AM 9:00AM 9:30AM 10:00AM 10:30AM 11:00AM 1:00PM 1:30PM 2:00PMAppointment Time RequestedThe following appointment times are generally available but our staff will call you to confirm your appointment after your request has been submitted. 1:00PM 1:30PM 2:00PMUsername Your request is not complete until you select "submit" at the bottom of this page.{all_fields}Additional Options Send me email updates 1-2 times per month. Add me as a user to this website.
