Insurance and Patient Forms

Interlake Medical Center, PLLC has put its most common forms here for your convenience. In most cases, if you provide us with the necessary insurance information, we  will bill your insurance claims for you.

There are numerous insurance companies, each offering different coverage. It is important that you acquaint yourself with your own coverage. Many policies have deductibles, which need to be satisfied before insurance payment takes effect.

All co-payments need to be paid at the time of the visit. Failure to pay at the time of visit will result in a $10.00 handling charge.

For new patients without insurance, a prepayment of $100.00 is required prior to each visit. If you have questions regarding your bill, please call the bookkeeping desk (425-747-3180).

Feel free to download any of these documents and prepare them in advance of your visit. You may find it more convenient to locate your insurance information and emergency contact information prior to your appointment while in the comfort of you own home. Each of these documents is in Portable Document Format (.pdf).

• Office Policies
• New Patient Registration
• Authorization to Disclose Heath Care Information to Interlake Medical Center, PLLC
• HIPAA Form
• New Patient General Information
• Authorization to Disclose Heath Care Information to Another Physician
• Notice of Privacy Practices