New Patient Information
New Patient Forms, Questionnaires, & Basic Office Policies
New Patient Packet as of November 2020
Please follow the link and print it out to complete.
You may return the forms by secure email (ask our receptionist how) by fax, mail, or person at the time of the first visit. Included are a brief introduction to the practice, an intake demographic form, a brief medical history form, and a payment policy form. Dr. Rotchford has few agreements with third parties, so be prepared to pay out of pocket or seek prior approval through your third-party coverage.
Please Read and sign the acknowledgment form at the end
Memo Regarding patients who seek specialized medical care for chronic pain and SUDS
This is for patients who want ongoing care by Dr. Rotchford for Chronic pain issues or substance use disorders. It is particularly pertinent for patients who might benefit from controlled substance prescriptions.
Memo about Washington State plans and Medicare Advantage Plans
This memo is directed to potential patients who have state-administered insurance: Medicaid, Apple Health, Basic Health, L&I, etc.
Regarding Your First Visit
After Dr. Rotchford listens to your medical history, provides a pertinent physical exam, and reviews your records, he will advise you of suitable options. We expect new patients to feel well listened to. Our plans for pain management and addictions are intended to be practical and workable. For your first visit, expect to be at the office for at least an hour. Please do not expect to have prescriptions for controlled substances filled during your first consultation with Dr. Rotchford.
After Hours Care
Dr. Rotchford is available by phone, generally within 24 hours, for established patients encountering concerns regarding their treatment plan. Please call the office number (360) 385-4843 for instructions on contacting our physician. If it is an acute or new medical issue, please first call your PCP. Dr. Rotchford is available for issues related to his prescriptions and associated chronic conditions.
Other Helpful Forms & Handouts — For New and some established patients:
Release of Healthcare Information (useful for records to be sent from one provider to another)
Policies regarding prescription refills and prior authorizations
Questionnaires
PAIN Questionnaires Packet for New Patients
This includes questionnaires that look for comorbid issues that may contribute to patients with chronic pain.
Agreements & Consent Forms
The following two forms are the agreements/consents related to controlled substances. Please review and be prepared to sign the agreement if you consider having us prescribe you any controlled substance. If you are expecting to be prescribed an opioid such as buprenorphine, morphine, oxycodone, tramadol, etc., please also review and be prepared to sign the opioid use agreement:
As a courtesy we have medical billers who bill third parties. Medicare has us bill them directly. For patients other than Medicare we expect down payments at time of service. Balances remain the responsibility of patients and after 60 days all balances are transferred to the patient. Prompt pay discounts are limited to 60 days. Out of network coverage for our services is often available but needs to be pre-arranged. We do not have agreements with any Washington State sponsored programs including Medicaid and L&I.