RUSSELL W. FARIA, DO, PC

Certified, American Board of Family Medicine

Welcome

Russell W. Faria, DO, PC

721 M Street NE, Suite 100

Auburn, WA 98002-4503

Contact Us

T: (253) 735-0260
F: (253) 735-0245





To better help us serve you, we would appreciate if you could fill out and sign the following forms. We have provided you with online access to the patient information forms that all patients must complete prior to their first visit.

You will need Adobe Reader to be able to open and print these files. Adobe Acrobat Reader is free from Adobe Systems.  

 

Click  to download Adobe Reader  

 

Welcome Check List

Our check list will help assure that  you  bring everything needed for your first visit

Patient Registration Form

Patient Demographics and  insurance information

Patient & Family Health History Form

This form gathers information about your family, including  your parents, grandparents and siblings  health history that can  assist us in helping you.

Review of Systems Form

A screening device to uncover potentially significant symptoms that might not otherwise apparent.

 These include symptoms related to the history of your present illness, other active problems which will aid in making a diagnosis

Financial  Policy

A statement of our payment, credit and financial policy requirements

Medical Records Release

To authorize the transfer of your personal medical files and information to Dr. Faria  and other healthcare providers

NOTICE OF PRIVACY PRACTICES

Dr. Russell W. Faria and Staff respect your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.

Notice of Privacy Practices

 

Privacy Notice describes how medical information about you may be used and disclosed, and how you can get access to this information. This Notice can be viewed either on-line or printed. 

Acknowledgement  Form

Please sign and bring with you the Privacy Notice Acknowledgment form. It indicates that you have been made aware of our Privacy Practices.