Patient Forms

Please print these four forms:  Informed Consent & Office Policies, Screening Questionnaire, JNM Contact Info Insurance Policy, New Patient Intake. They will likely take ~ 30 minutes to fill out.

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:

a.  Fill out, scan or photograph and email back to

b. Fill out and fax to 206-905-0696

c.  Fill out and mail (must be received two business days before your office visit, so this is the least desirable approach).

d.  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. 


JNM InformedConsent _Aug2017.pdf
Adobe Acrobat Document 135.2 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

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

Purchase Professional-Grade Supplements


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