Patient Forms


Feel free to download, print, and fill out the following forms before your appointment -

  • Patient Information - for new patients: includes demographics, consent to treat and financial policies.
  • Intake Forms - for new patients: please print, complete and bring to your first appointment.  Please print this single sided.
  • Release of Information - complete this form if Dr. Wilkie needs permission from you to obtain records from another facility
  • Diet Diary - a simple way to track your food intake, and be prepared to discuss at your visit, if asked. 
Vanessa Wilkie, ND
2025 112th Ave NE, #300
Bellevue, WA 98004
Phone: 425-201-9700
Office Hours

Get in touch