Uma  Clinic                                                                            (206) 293-4927
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Healthcare Forms

To be prepared for your first visit, please print and fill out the following healthcare forms: 


        1)  Personal Health Information

        2) Billing Information ( In addition to #1, Only fill out if MVA or LnI)


  1. Personal Information Intake
  2. a) Weight Loss Questionnaire (In addition to #1)      b) Smoking Cessation Questionnaire (In addition to #1)

If you are a COACHING client and/OR if we are doing our first session over the PHONE we need  to   receive your Initial Intake forms at least 24 hours in advance of your session so we can best prepare for your session, please email these to

We look forward to seeing you.

As a reminder:
All COACHING sessions are over the phone.
Hypnotherapy sessions are either over the phone or in-person.
If you purchased a Groupon you MUST schedule ONLINE.
You need a code to get into the building, it will be provided in your confirmation email.

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