Book An Appointment

Please complete form below with your appointment interest.

  • We strive for a general response time of less than one business day. 

  • Existing patients can go to Onpatient portal and schedule online - see link to the right.

Please review privacy statement below the form prior to submitting your form.


WE ARE ON A SUMMER VACATION UNTIL SEPTEMBER 5TH!

WE LOOK FORWARD TO ASSISTING YOU WITH SCHEDULING YOUR NEW PATIENT APPOINTMENT WHEN

WE RE-OPEN IN EARLY SEPTEMBER.


Name *
Name
Cell Phone *
Cell Phone
Month/Day/Year
~ Word of mouth ~ A friend - if so, whom? We'd like to thank them! ~ Google ~ Your insurance ~ Saw Lise Martin, ARNP at a different health clinic Please let us know, thanks!
Your initial visit will take 60-90 minutes, depending on your concerns and medical history, so please allow that much time when scheduling.

PRIVACY NOTICE: Information you submit using this form will be emailed to Seattle Women’s & Moms’ Clinic. Please be aware that e-mail is not a secure method of communicating confidential information. It is impossible to assure privacy of any communication by electronic means. If you are uncomfortable with this possible limitation to your privacy, please communicate by other means. To protect your more sensitive information, we offer a secure patient portal through onpatient. We also offer HIPAA compliant texting through OhMD, a site that makes uploading images and IDs/insurance cards, very easy. For more information, please read our Notice of Privacy Policies.


Thank you for sharing your information & your interest in our clinic!

We look forward to following up with you!

If you have not heard back from us in 48 hours, please contact us via email - care@seattlewomensclinic.com