office (425) 637-2340
fax (425) 637-0036

Appointments

Making an appointment, please call us at (425) 637-2340 and we will reserve appropriate amout of time based on your concerns.

Our staff Ilona and Albina are very personable and knowledgeable. They speak both English and Russian languages.

New patients

Please take a moment to print out the forms below, fill them out and bring with you to your first visit

Health History

Patient Information

Immigration medical exam patients

If you are making appointment for medical examination (Green Card), please take a moment to download the forms below, fill out Applicant Information,Health History,List Medications section only (1st page) and email to us at office@kutsysmedicalpractice.com whith a subject Medical Examination -<Your Last First Name>. We will print the form for you and you will sign it during your visit

Please do not forget to type your A-Number (Alien Registration Number) in Application Information section

Please bring with you the following documents:
  • Insurance card (if available)
  • Immunization record(if available, for kids are required)
  • Passport or Driver License

    • Medical Examination Form (Office Worksheet)

    Canceling an appontment

    In case of canceling an appointment, please give us a call 24 hours in advance