Patient Resources

Patient Resources

New Patients

Please take some time to thoughtfully and thoroughly fill out the paperwork before your visit. If you don’t have access to a printer or prefer to fill out the paperwork at our office, that’s ok too, but please arrive at least 20 minutes early to give yourself enough time. It may seem boring, but the more thorough you are with the paperwork the faster we can help you achieve your goals and that gives us more time for treatment during your appointment. Click here for frequently asked questions about cost, insurance, etc. PAPERWORK FOR ANY PAIN COMPLAINT: Informed Consent Intake General Pain Index ***For TMJ and Jaw issues specifically, these two are also needed: TMD Disability Index TMD Symptom Intensity PAPERWORK FOR THYROID, ADRENAL, METALS, CHEMICAL SENSITIVITIES, AUTOIMMUNE PROBLEMS, etc.: Informed Consent Intake Metabolic Assessment Form MEDICARE Patients If you are on Medicare, please fill out the New Patient Paperwork above, and also the paperwork listed below. (Please Note, we cannot bill Medicare for any services rendered and payment is due at the time of service. We offer a discount to patients 65+, but unfortunately Medicare will not pay for our services and we cannot bill Medicare. In addition, we cannot provide a Super Bill for billing of supplemental insurance. All payment would be out of pocket and is due at the time of service). Medicare Policy ABN


The Founder Exercise Intelliskin for postural support Myo Munchee for myofunctional therapy, mouth and cranial development

Jason Scoppa, DC, CSCP, CCSP®
Bellevue location:
Northwest Structural Medicine
12330 NE 8th St., Ste. 202, Bellevue 98005
Lynnwood location:
Balance Epigenetic Orthodontics
2322 196th St. SW, Ste. 201. Lynwood, WA 98036

© 2018 by northwest structural medicine, pllc