New Patient Application

This form collects information from potential patients wishing to be seen at Bellingham Health. Please provide accurate and complete answers so we can:
• Have accurate contact information for communicating with you.
• Assess your needs relative to clinic capabilities and the likelihood of reaching your goals.
• Validate your insurance information to ensure smooth billing.

If your responses lead us to believe that Bellingham Health can help you, we will set up your portal account, and you can begin making appointments, communicating with us, reviewing labs, making payments, and more. If we believe your needs are better served elsewhere, we may suggest places to seek help.

Normally, we can review and respond to your application within a business day or two.  Occasionally it may take up to a week.  Please call and leave a message if you do not hear from us in a week.  

(If you are completing this form on a phone or other mobile device, you may need to rotate it 90 degrees to landscape mode for final submission)