Below you will find links to the Client Intake Form and Client Consent
These forms are MANDATORY
You may complete these forms online
We look forward to meeting you at your first appointment!
The Intake Form and Consent Form are the two primary and mandatory documents for your first appointment. Please note that these documents must be completed fully and throughly and all signatures must be present where indicated for treatment to proceed. Please feel free to print these documents and complete them prior to your first appointment.
The Client Survey is a voluntary form that you may fill out and email to the director at firstname.lastname@example.org to rate your satisfaction with the services you have received. We also have copies at the office you may utilize.
The Release of Information is a document needed to release information to any party not indicated on the consent form. This might include lawyers, doctors, courts, family members, etc. A separate version of the release of information is needed for each separate party or entity for which information should be released.
If you are an existing client, please let us know if and when you obtain new health insurance coverage as soon as possible. Please complete the form below to authorize verification of th e new information and billing of a new payer or plan.
If you are an existing client and have a change to your card on file, please complete the form below.