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    • Home
    • Our Team
    • Services
    • Location
    • Insurance
    • Patient Forms
    • Patient Education
  • Home
  • Our Team
  • Services
  • Location
  • Insurance
  • Patient Forms
  • Patient Education

About our clinic

The Initial Visit

Please be 20 minutes early to your appointment time for your first visit. This allows us time to finish paperwork and answer any questions you may have.

Late Arrival Policy

 We understand that patient families may experience unforeseen delays while traveling to the clinic for a scheduled appointment.  However, patients arriving more than 10 minutes late have missed their appointment time. We will do our best to try and accommodate late patients by offering new appointment options at a later date. If you miss your appointment time, there will be a $25 cash fee placed on your account. (This is patient responsibility, not insurance)

Cancellation/Missed Appointments Policy

We understand that patients may need to cancel or reschedule appointments from time to time. As a courtesy, patients are asked to contact the office 24-hours in advance if they need to cancel or reschedule their appointment. This enables us to offer the appointment time to another child in need of our healthcare services. If you do not cancel or reschedule your appointment there will be a $25 fee applied to your account. This is a personal fee and is not covered by insurance. Our policy only allows for three no shows per family or, you may have to find care elsewhere.

Vaccines - Immunizations

 Washington State Immunization Registry Airway Pediatric Clinic does participate with the Washington State Immunization Registry.  To get a copy of your child's immunization record, you must create an account at:   Access your Family's Immunization Information | Washington State Department of Health 


If you would like a printout of your child's immunization record from our office. There is a $5 dollar cash fee. Please be aware there is a 48-hour grace period for paperwork pick-up. 

First Visit Forms

HIPAA / Office Policies and Consent to Treat (pdf)Download
New Patient Registration (pdf)Download
TREATING MINOR WITHOUT A PARENT OR LEGAL GUARDIAN (pdf)Download
ROI - AP (pdf)Download

Mental Health Forms

Postnatal Depression Scale (EDPS) (pdf)

Download

Patient Health Questionnaire (PHQ-9) (pdf)

Download

Vanderbilt Parent (pdf)

Download

Vanderbilt Teacher (pdf)

Download

Vanderbilt Parent Follow-up (pdf)

Download

Vanderbilt Teacher Follow-up (pdf)

Download

Pre-Appointment Behavior Evaluation Form (pdf)

Download

Childhood Autism Spectrum Test (pdf)

Download

School Forms

Please bring your required school paperwork completed.
Sports Physical formMedication at SchoolInhaler at schoolImmunization exemption EPI pen at school

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