The objective of this study was to describe and compare the practice patterns of naturopathic physicians in Washington State and Connecticut, USA. Telephone interviews were conducted with state-wide random samples of licensed naturopathic physicians and data were collected on consecutive patient visits in 1998 and 1999. One hundred and seventy practitioners were interviewed and 99 recorded data on a total of 1817 patient visits. Naturopathic physicians in Washington and Connecticut had similar demographic and practice characteristics. Both the practitioners and their patients were primarily white and female. Almost 75% of all naturopathic visits were for chronic complaints, most frequently fatigue, headache and back symptoms. Complete blood counts, serum chemistries, lipids panels and stool analyses were ordered for 4 to 10% of visits. All other diagnostic tests were ordered less frequently. The most commonly prescribed naturopathic therapeutics were: botanical medicines, vitamins, minerals, homoeopathy and allergy treatments. The mean visit length was about 40 min. Approximately half of the visits were paid directly by the patient.