New Patient Forms

Nutrition Northwest Co
Angela Pifer, MS, Certified Nutritionist



For your convenience, the intake paperwork is offered in PDF. Though the forms are fillable online, you will not be submitting these directly to me through this site (this is not HIPPA compliant). Please fill in the paperwork, save it to your desktop, print and fax your paperwork to me.

Please fill out the new patient paperwork, digestive wellness questionnaire, health history timeline and include a copy of any and all labs that you have access to and return these via fax: 425.274.1554 at least 48 hours prior to your appointment.

I review all intake paperwork prior to your appointment so that I am prepped and ready for your intake session.

**Please make sure that the forms are saved WITH your data prior to closing the fillable PDF form**

New Patient Intake Form

Digestive Wellness Assessment

SIBO Questionnaire

Health History Timeline