Patient Questionnaires for Care Visits

If you were asked to fill out a questionnaire before your appointment, you may look it up by department or specialty. Print, fill in your responses, and take to your visit.

All questionnaires are in PDF format.

Primary Care

These questionnaires are for preventive care appointments with your primary care provider.

Well-Care, Preteens 10-12
Well-Care, Teens 13-17
Well-Care, Young Adults 18-21
Well-Care, Adults 22-64
Well-Care, Adults 65+

Women's Health Care/Gynecology

For visits with a women's health care provider about a health problem or concern:
Women's Health Care
(For a preventive care visit with a women's health care provider, fill out the appropriate questionnaire in the Primary Care section.)

For pre-natal visits with an OB/GYN (questionnaire instructions):
Pregnancy Care

Other Departments and Specialties

Choose your questionnaire by the department or specialty where your appointment is scheduled.

Activity, Sport, Exercise Medicine (ASEM); North Region*
Activity, Sport, Exercise Medicine (ASEM); South Region**
Behavioral Health Services
Internal Medicine, Consultative
General Surgery
Nephrology (kidney)
Neurosurgery Spine Center
Orthopedics; North Region*
Orthopedics; South Region**
Pain Clinic
Physical Medicine & Rehabilitation⁄Pain
Radiation Oncology
Sleep Medicine

Medical Centers with orthopedic and ASEM specialists:
*North Region: Seattle and Bellevue medical centers
**South Region: Tacoma, Olympia, Port Orchard, and Silverdale