New Patient Information …

                                         New Patient Information
        Welcome to Bastyr Center for Natural Health, the teaching clinic of Bastyr University. Thank you for
choosing us as one of your health care providers. We are a teaching clinic, and you can expect to be seen by one or
two advanced student clinicians, working as a team with an experienced, licensed health care professional--
naturopathic physician, acupuncturist, psychologist, or registered dietitian--who supervises your care. Please take a
few minutes to read this information. It contains many of our basic business policies and is designed to assist you in
your business interactions with the clinic. Please feel free to call us at 206-834-4100 and talk to the receptionist if
you need clarification on any of these issues.


 PAYMENT
 If you do not have insurance, or if we are not yet billing your insurance company, we appreciate your payment in full at
 the time services are rendered. The clinic accepts cash, checks, and Visa and MasterCard. If you pay for your appointment
 in full by cash, credit card, or check at the time of service, you will receive a time-of-service discount.

 INSURANCE COVERAGE
 Please check with us regarding which insurance companies our providers are contracted with. Bastyr Center for
 Natural Health will bill your insurance company for you if your policy covers alternative care. If your insurance
 company doe not cover the visit, then the bill will become patient responsibility. Therefore, we strongly
 encourage patients to see if their particular coverage includes alternative care benefits before they schedule an
 appointment.

 INCOME BASED ADJUSTMENT
 Some of our departments offer discounts based on income. Please advise us prior to your appointment if you
 wish to apply for a discount, and we will give you the application. Your application must be approved before the
 discount can be applied.

 CANCELLATION/NO-SHOW POLICY
 Due to the high demand for appointments at the clinic, we require notification 24 hours in advance if you cannot keep your
 appointment. Failure to comply with this policy may result in your being charged for the missed appointment or in being
 placed on a Restricted Scheduling Status.



LAB CHARGES

Bastyr contracts with Pacific Physicians' Laboratory (PPL) as their main reference lab. Lab fees are based on who
performs and analyzes the test as well as the extensiveness of the specific tests. In addition, lab fees do not include a
phlebotomy blood draw fee. PPL will bill you or any listed insurance for payment. This excludes Medicare as
Medicare dos not cover any services ordered by a naturopathic doctor. In this case the patient will remain financially
responsible for all charges. Bastyr also utilizes kits from other outside laboratories. If your provider has ordered
testing from a special kit, payment is sent along with the specimen. In addition PPL will charge a phlebotomy blood
draw fee and/or a special handling fee. Payment for these will be due at time of service; please contact the lab for
details 206-834-4113.


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PATIENT RIGHTS AND RESPONSIBILITIES

Patients and providers have rights and responsibilities to one another to insure that the best health care services are
provided.

    Patients and providers have the right and responsibility to treat one another respectfully.
    Patients have the right to confidentiality when receiving care from providers.
    Patients have the responsibility to supply accurate and complete medical history information to the provider.
    Patients have the right to know that a record will be kept of the health care services provided to them. They
    may ask to view, obtain a copy, or amend or correct that record. Providers will not disclose a patient's record
    to others unless directed to do so, in writing, by the patient, or unless the law authorizes or compels them to do
    so. (RCW 70.02.120)
    Providers have the responsibility to inform patients about their health condition and include the patient in
    decisions affecting their care.
    Patients have the right to bring questions, concerns, complaints, or compliments about any aspect of their care
    or service to the individual provider, their health plan, or provider network.

MEDICAL RECORDS

Please be aware that we are unable to provide medical records, including lab results, on a walk-in basis. In all cases a
medical records release form must be filled out, including patient signature and complete date, in order for us to
comply with the law and protect your confidentiality. Requests will be processed and records mailed out within 15
working days. There is no charge for records mailed directly to other health care providers. However, there is a
charge (after the first ten pages) for records released directly to a patient.

SPECIAL ACCOMMODATION

If you require special accommodation due to disability, please contact the Patient Services Manager at 206-834-4142
or the Patient Services Supervisor at 206-834-4173 prior to your visit. The building is wheelchair accessible via the
Stone Way ramp entrance on the northwest side of the building and by the elevator located in the northeast side of
the parking garage through the automatic sliding doors. Provision for a sign language interpreter can be made with
adequate advance notice.

DIRECTIONS

Our address is 3670 Stone Way N., Seattle, 98103. From I-5, take exit 169 to 50th Street North. Go west on 50th
Street for about a mile until you reach Stone Way. Make a sharp left (south) onto Stone Way and continue south
until you cross 38th Ave N., and our clinic will be on your left. Please check in on the first floor for acupuncture and
Chinese herbal medicine appointments. Check in on the second floor for all other appointments. Our main
dispensary is located on the first floor and can be accessed through the Stone Way entrance.

PARKING & BUSES

Free parking is available in the underground garage under the clinic building through the entrance off Stone Way.
Parking is also available on the streets around the clinic. Several buses serve the Wallingford/Fremont areas
(#16, #26, #31, #45, and #74). For route and schedule information, call Metro at 206-553-3000.