Telehealth Medicare Benefits Expanded as a Lifeline for Patients During the Coronavirus Outbreak. Call 425-243-5773 to Schedule Your Appointment.

For your convenience please text us at 206-695-2707 for a prompt reply.

Patient Forms

Richard E. Repass, MD Contents Patient Forms

 

Release of Information  (Easy Electronic Signature Link)  (PDF Printable Copy)

Notice of Privacy Practices  (Easy Electronic Signature Link)  (PDF Printable Copy)

Financial Policies and Procedures  (Easy Electronic Signature Link)  (PDF Printable Copy)

Telemedicine Consultation Consent  (Easy Electronic Signature Link)  (PDF Printable Copy)

Email and Texting Information and Consent  (Easy Electronic Signature Link)  (PDF Printable Copy)

What we offer

BR+ NAD+ Services

 
Location
Revolution Psychiatric and Addiction Treatment
2737 78th Ave SE, #100
Mercer Island, WA 98040
Phone: 425-243-5764
Fax: (888) 417-4346
Office Hours

Get in touch

425-243-5764