New Patient Appointments

New patients can schedule a primary care appointment by filling out the form below. Due to health care privacy laws, we will not respond via email. Our New Patient Services team will call you to confirm. Or, you can call New Patient Services at 206-329-1777 between 8 am and 5 pm Monday – Friday.

To schedule a specialty care appointment, please call the provider’s office directly.

Please enter information in English. Language assistance services are available free of charge.

First Name *

Last Name *

May we leave you a voicemail at the number you list below? *

Yes

Phone number (including US area code) *

Best time to reach you

During our office hours: Monday-Friday 8 am to 5 pm

Type of medical insurance

How did you hear about us?

Please do not include any confidential, medical or personal information. If you would like to phone The Polyclinic for new patient appointments, please call 206-329-1777 during regular business hours for assistance.

If you are experiencing symptoms that are emergent or life threatening, please seek attention immediately by calling 911.

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Math question * 14 + 4 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.