We use a HIPAA-compliant vendor to securely deliver client forms submitted through our website.
FORMS NEEDED BEFORE YOUR FIRST APPOINTMENT
Please click on the buttons below to fill out and submit forms on-line.
Adult Intake Forms Child Intake FormsIf you have Medicare insurance, please complete the required Advanced Beneficiary Notice.
Advanced Beneficiary NoticeIf you need to submit a Release of Information form, you can do so here:
Release of Information FormSample Completed Release of Information Form
Emergency Contact Release of InformationIf you do not have insurance, you may have the option for services provided by an intern at no cost. If you are interested in that option, please complete this form:
Consent for Services by a Student InternDOWNLOAD & PRINT OPTION
If you prefer and if you have access to a printer, you may download, print, complete and scan the entire intake packet and use the button below to upload the forms to us.
UPLOAD FORMS
You can use this button to upload any documents to us, including intake packets, insurance forms, and other items staff may request. Click the button, fill out the information requested, and then click the button labeled “Click to Upload”. This will let you browse your computer/device and select a file to send to us.
File Upload Form
