Whidbey Island Internal Medicine

77 N Main St.
Coupeville, WA 98239

Need to Contact us or Have Questions?
Phone: (360) 678-4440
Toll Free: 1 (877) 678-4440
Fax: (360) 678-9244

Patient Forms


Want to get a head start?

New Patient Information

Bring the following to your first appointment:

  • Completed Medical Questionaire Form
  • Competed Medical Record Release Form
  • Financial Policy
  • Patient Information Form
  • Permission to Share Limited Health Information Form
  • Your Insurance Card(s)
  • Your Photo ID
  • Your Co-pay (if you have one)
  • Any Prescription and Over the Counter Medication(s) You are Currently Taking with the Original Container(s)