Diagnostic Appointment Requests: Washington State    

 

Click here to view our FASD Clinic Brochure.

A FASD diagnostic evaluation is conducted in a single 4-hour appointment. Click here to learn more about the 4-hour appointment.

Click here to learn more about the cost of a FASD diagnostic evaluation.

To request an appointment for a Fetal Alcohol Spectrum Disorder (FASD) diagnostic evaluation at one of the Washington State FAS Diagnostic & Prevention Network (FAS DPN) clinics, we need you to complete and submit our New Patient Information Form (NPIF).

The NPIF allows you to share with us your concerns about the patient and why you are seeking a FASD diagnostic evaluation. To be seen at one of our FASD Clinics, an individual must have a confirmed prenatal alcohol exposure history. We see patients of all ages (newborn to adult).

 

There are 3 ways you can obtain our New Patient Information Form (NPIF):

  1. Download the NPIF: You can download the NPIF by clicking here. Complete the form and mail it to us following the instructions provided with the NPIF.

  2. Call us to Receive the NPIF in the Mail: You can also obtain the NPIF by calling the University of Washington FAS DPN Clinic (206) 598-7666. You will be asked to leave the contact information below. We will mail the NPIF to you, with instructions for how to complete and submit the form to us.

  3. Email us to Receive the NPIF in the Mail: Or you can obtain the NPIF by emailing us at fasdpn@u.washington.edu with Appointment Request in the subject line, and the information below in the body of the email. We will mail the NPIF to you, with instructions for how to complete and submit the form to us.

    • Please provide this information if you are requesting we mail the NPIF to you:

      • Your first and last name.

      • Your area code and telephone number.

      • The first and last name of the person to be evaluated.

      • The date of birth of the person to be evaluated (please tell us the month, day and year of birth).

      • The address you would like theNPIF to be sent to.



  4. When we receive your completed NPIF, we will review it and send you a letter informing you of the status of your request and when you can expect to hear from the Clinic Coordinator to schedule an appointment.

  5. The University of Washington FAS DPN clinic will forward your appointment request to the FAS DPN clinic closest to you, with your permission. The FAS DPN clinics are located in Seattle, Everett, and Yakima. You are welcome to request an appointment at any of our clinic locations.

  6. If you would like to make a request directly to the other FAS DPN clinics in Washington State, you may do so by using the information provided in the Clinic Locations section of this Web site.

  7. To request a diagnostic appointment at a FASD clinic outside Washington State, click here to link to our web page that lists clinics across the U.S.