NCS New Patient Forms
Payment Information
For your convenience we have added an online form that will allow you to send your payment information to us in a secure format. Please note, as an added level of security, your payment information will automatically be deleted by the system after it has been viewed for processing.
Payment Authorization
Northwest Cancer Specialists makes it easy to make monthly payments. Two recurring payment options are available - direct withdrawal from a bank account or an automatic credit card payment. Simply, print and complete the appropriate form. Then either mail with your next payment or give to the financial counselor at your next appointment.
Medical History Questionnaire
The questionnaire is designed to help your doctors know your general medical history and to save you time during your initial evaluation. Because the information is important for your health care, please fill it out carefully and completely. This will become part of your medical record; all information is strictly confidential. Please bring the completed medical history questionnaire with you to your first scheduled appointment.
Insurance
As cancer specialists, we are keenly aware that modern cancer care is often very expensive. We are sensitive to this fact and will work with you to provide the most effective treatment options while keeping an eye on costs. We see all patients referred to us for care. Our goal as physicians is to provide the best medical care for all of our patients. For more Insurance and billing information, click here. Please print, complete and bring the assignment of benefits and financial responsibilities form with you to your next appointment.
Privacy Policy
We are required by law to maintain the privacy of your health information and provide you notice of our legal duties and privacy practices with respect to your health information. We will abide by the terms of this Notice. Please print, complete and bring the Notice of Privacy Practices with you to your next appointment.
Patient Bill of Rights
A Patient's Bill of Rights is a statement of the rights to which patients are entitled as recipients of medical care which articulates that patients should be provided with information, offered fair treatment, and autonomy over medical decisions.
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