Patient Forms

Please print these five forms:  Informed Consent & Office Policies, Screening Questionnaire, JNM Contact Info Insurance Policy, New Patient Intake. They will likely take at least 35 minutes to fill out.  DO NOT FILL OUT ANY FORMS ON THE CHARM SITE AS THEY ARE OUTDATED, USE ONLY THE PDFs BELOW


Forms need to be received two days before your First Office Visit or you will be cancelled.  Dr. Kimball reads every word ahead of time and there is too much content to read immediately prior to your visit.  


Here are your options for how to return the forms: (you must download and print these forms as Dr. Kimball likes to see patient’s handwriting and does not like typed forms)

  • Fill out and fax to 206-905-0696
  • Fill out and mail (must be received two business days before your office visit)
  • If you do not have a computer, we can mail you the forms and you can      mail them back.  This process will take a total time of likely 10 business days 
  • If you would like to come to the office and pick up forms, please email to: 

We no longer suggest taking pictures of forms and emailing as occasionally the “readability quotient” is sub-par. 


JNM InformedConsent March 12, 2020.pdf
Adobe Acrobat Document 153.9 KB
JNM Contact Info and Insurance Policy.p
Adobe Acrobat Document 84.4 KB
Screening Questionnaire
Screening Questionnaire.pdf
Adobe Acrobat Document 92.3 KB
New Patient intake form.pdf
Adobe Acrobat Document 264.1 KB

Notice of Privacy
pdf_JNM Notice Of Privacy Practice_June
Adobe Acrobat Document 92.6 KB
TeleMedicine Informed Consent
TeleMedicine Informed Consent.pdf
Adobe Acrobat Document 42.1 KB
JNM COVID Informed Consent
JNM COVID informed Consent.pdf
Adobe Acrobat Document 57.2 KB

You will be instructed after the first visit regarding the following two forms.

Nutritional Assessment
Nutritional Assessment Questionnaire.pdf
Adobe Acrobat Document 263.2 KB
Diet Diary
JNM Diet Diary.pdf
Adobe Acrobat Document 48.6 KB

Junction Naturopathic Medicine’s Approach to Personalized and Integrative Care: Helping You Get Healthier!

JNM Natural Medicine Brochure.pdf
Adobe Acrobat Document 1.4 MB

Access Metagenics

Access Fullscript


The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.”

Thomas Edison, January 2, 1903

Dr. Kimball’s

Personalized Systemic

Periodontal Program


Integrative Medicine

Services for Optimal Oral

Health –addressing root


PSPP Brochure
PSPP Brochure.pdf
Adobe Acrobat Document 636.0 KB