We are located across
from Walmart in the

Quil Ceda Retail Center:

8825 34th Ave. NE, Suite A

Tulalip, WA 98271

• Phone:
• Fax:

• 360.716.2660
• 360.716.3660

Patient Forms

• Flu Shot In-take Form
• GO GREEN Authorization Form
• Multi-dose Compliance Packaging Program
• New Patient Intake Form
• Non-safety Cap Authorization Form
• PHI Disclosure Authorization
• Pick-up Authorization Form
• Travel Clinic In-take Form
• Pharmacy Sourcing Request Form

Consent Forms

• Tulalip Clinical Pharmacy Practice Policy
• Tulalip Tribes Notice of Privacy Practices
• Kiosk Waiver