Patient Forms

Patient Forms

Please complete these forms before your initial appointment. If you also need to request medical records or lab results from your current provider, please complete the Medical Release form in the Existing Patients section below.

(Your current provider would be listed in Section 2, SVC would be listed in Section 3).

New Patient Intake Forms

Existing Patients

If you need a copy of your SVC medical records for yourself or sent to another medical office, please complete the following form and return to us. Fax: (509) 290-6305 or email office@vitalitymenscenter.com

(SVC would be listed in Section 2).

Medical Release
Payment Form