Get Bastyr University Intake Form

Completing the Bastyr University Intake Form online is an important step in beginning your healthcare journey. This guide provides clear and supportive instructions to help you accurately fill out each section of the form.

Follow the steps to successfully complete the intake form.

1. Press the ‘Get Form’ button to obtain the intake form and open it in an online editor.
2. Begin by entering your personal information in the designated fields. This includes your full name, address, city, state, and zip code. Ensure that all details are accurate and complete.
3. Provide your contact numbers. Specify which number is best for leaving messages, following HIPAA regulations. Include your email and date of birth.
4. Fill in your age and gender. Choose your marital status from the available options and indicate who you live with to give more context about your situation.
5. Input your occupation, expected working hours each week, and if applicable, your employer's name and work address.
6. Provide your health insurance information, including the company name, address, phone number, member number, and policyholder’s name.
7. Indicate how you heard about the clinic and whether any family members have been patients at this clinic before.
8. Provide an emergency contact’s details, including their relationship to you and phone number.
9. Complete the health history questionnaire by answering yes or no to the questions, and providing additional details where necessary.
10. Review all entries for accuracy. Once satisfied, save changes to the form, or choose to download, print, or share the completed document.

Ready to begin your health journey? Complete your intake form online today.