Before your first appointment at Bastyr University Clinic, you must complete a Patient Intake Form which includes the new patient information form and health history. It may be helpful if you can include copies of previous tests, lab results, and the names of any medications or natural supplements you are currently taking. Please download the Patient Intake Form (below) and send it back to the clinic, along with any other information, using one of these options:
- Clinic fax line: (858) 246-9710
- Mail to the clinic: Bastyr University Clinic, 4110 Sorrento Valley Blvd., San Diego, CA 92121
Download and print the PDF documents below (Download free Adobe Reader software):
- Patient Intake Forms
- Medical Records Release Form
- Application for Income-Based Rate Adjustment
- Homeopathy General Form
Additional Forms
A parent/legal guardian must attend a minor’s first visit with Bastyr University Clinic. For parents or legal guardians who cannot be present for subsequent visits, please fill out this form: Permission to Treat a Minor Without a Parent/Guardian Present.