New Patient Forms

Before patients (both bariatric and cosmetic) come in for an appointment for the first time with our office, we require two pieces of paperwork.

If you’re looking for a form that isn’t on this list, please check our office forms page or feel free to contact our office and we will be happy to assist you.

New patient paperwork:

1. Insurance Verification form: Our patient coordinator will call your insurance company to verify your coverage for surgery and office visits.

2. Comprehensive Patient History packet: This 10-page packet is used to create your chart and is reviewed by Dr. Srikanth before your appointment.

Please return all new patient forms to our Federal Way office:

Email:   pc@c4wls.com
Fax:       253-815-7708
Mail:      34509 9th Avenue S, Suite 103
               Federal Way, WA 98003

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