William A. Portuese, M.D.
1101 Madison Street, #1280
Seattle, Wa. 98104


Tel:(206) 624-6200
Fax:(206) 624-0244

Patient Forms

• Click the link on the left to print a form directly from your web browser, or
• Click the icon to download the Adobe Acrobat* version of the form.

Patient Registration Form

System Review

Acknowledgment of Privacy Practices

Patient Medical Information

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Internet Consultation

Name and email are required *