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New Patient Appointment Request Form
New Patient Appointment Request Form
19Questions
New Patient Appointment Request Form
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    Pick a Date
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    • Male
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  • 9
    We take Pacific Source, First Choice, Medicaid/OHP, Pacific Source Medicare, United, Regence, Blue Cross Blue Shield, MODA (Not 360 plans), Tricare, HMA, Health Comp, & Providence.
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  • 13
    Please check appropriate box(es):
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  • 14
    OHP/Medicaid/Medicare are not eligible for Functional Medicine
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    Havilah Brodhead has trained in Functional Medicine and incorporates this into her primary care.  Some patients would especially benefit from this type of root cause medicine. 

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    Please provide some history about your concerns.
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  • 17

    Thank you for submitting a brief overview of your concerns and history.  We will review your case and let you know within 5 days if we can get you scheduled with Havilah Brodhead.

    Marie Mency FNP, Rachel Query FNP, and Jeremy Brodhead FNP are also all offering integrative primary care and are accepting new patients as well.  If we are unable to accomodate you into Havilah's care we always encourage you to establish with our other members of our incredible team.

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  • 18

    Next Steps to Schedule your 1st appointment

    1. Wait until you see an email to register for your patient portal within 2 business days.
    2. After this we will call to schedule your first appointment.
    3. If you do not hear from us please feel free to call us.

    We can ussually get you scheduled within 1-2 weeks!

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