How to get your recommendation

1. First of all, determine if you have a qualifying condition. Please refer to RCW 69.51a.010, which is posted below.
2.If you qualify, call your personal doctor and have them release your medical records to you. We only need at least 3 chart notes from within the past 3 years that document your condition.
3. Then fax or email your chart notes to (206) 319-5196 or Make sure to include your phone number.
You may also download a Release of Information form to have your doctor’s office send the information for you. However, please contact us to ensure that we have your phone number. You will be contacted within 2-3 business days to schedule an appointment.  In the meantime, you may read the HIPAA Notice. If we can schedule your appointment, then you may fill out and sign the forms in this Patient Intake Packet to bring with you.

RCW 69.51A.010
“Terminal or debilitating medical condition” means:
A. Cancer, human immunodeficiency virus (HIV), multiple sclerosis, epilepsy or other seizure disorder, or spasticity disorders; or
B. Intractable pain, limited for the purpose of this chapter to mean pain unrelieved by standard medical treatments and medications; or
C. Glaucoma, either acute or chronic, limited for the purpose of this chapter to mean increased intraocular pressure unrelieved by standard treatments and medications; or
D. Crohn’s disease with debilitating symptoms unrelieved by standard treatments or medications; or
E. Hepatitis C with debilitating nausea or intractable pain unrelieved by standard treatments or medications; or F. Diseases, including anorexia, which result in nausea, vomiting, wasting, appetite loss, cramping, seizures, muscle spasms, or spasticity, when these symptoms are unrelieved by standard treatments or medications; or
G. Any other medical condition duly approved by the Washington state medical quality assurance commission in consultation with the board of osteopathic medicine and surgery as directed in this chapter.”


We no longer offer Teleconferencing appointments as the new law states that we must perform a physical exam.