Book An Appointment

PLEASE NOTE - The office is closed Tuesday July 16th through Friday July 19th, so we apologize for delayed replies. Thank you for understanding!

Please use the form below to tell us about 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.

Name *

Name

First Name

Last Name

Email Address *

Cell Phone *

Cell Phone

(###)

###

####

Your date of birth *

Day/Month/Year

Insurance provider *

How can we help (in other words, what kind of visit are you in need of)? *

How did you learn hear about us? *

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.

What day of the week and approximate time of day is preferred?

Your initial visit will take 60-90 minutes, depending on your concerns and medical history, so please allow that much time when scheduling.

Anything else you'd like to share:

The office is closed Tuesday July 16th through Friday July 19th, so we apologize for delayed replies. Thank you for understanding!

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 reviewing it and following up with you.

Email Us

The best way to reach us is via email, care@seattlewomensclinic.com.

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