Print Page

New Patient Kit

The New Patient Kit includes important forms and quick links to other information on our Web site that will help you prepare for your first visit at Cancer Care Northwest.

Please download and fill out the forms below that relate to you. Bring the completed forms to your first appointment. Not all questions may pertain to you, but we ask that you complete all forms to the best of your ability. This information helps us provide the best possible care based on your current and past general health and any related family history.

Forms

Click on the link to download

• Assignment of Benefits
• New Patient Questionnaire: Please fill out the questionnaire that best suits your needs:
  • General Oncology/Hematology Patient Questionnaire
  • Gynecologic Patient Questionnaire
  • Breast Care Patient Questionnaire
• Medicare Secondary Payer Screening Form (Medicare Patients Only!)
• Patient Rights and Responsibilities (no signature needed)
• New Patient Checklist

PET/CT Forms

• PET/CT Brochure
• Preparation for Patients Undergoing PET/CT Scans
• CT Scan Prep Form
• CT IV Contrast Prep Form
   

Quick Links

What to Expect at Your First Visit
FAQs
How We Are Different
Physician Bios
Our Locations/Clinics (includes maps and directions)
Contact Information
Cancer Support Groups
Individual, Marriage and Family Counseling
PET/CT Brochure
Nutrition Services