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 Forms

 

If you have Medicare insurance, please complete the required Advanced Beneficiary Notice.

Advanced Beneficiary Notice

 

If you need to submit a Release of Information form, you can do so here:

Release of Information Form

 

Sample Completed Release of Information Form

 

Emergency Contact Release of Information

 

If 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 Intern

 

 

DOWNLOAD & 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.

Child & Family Intake Packet

Adult Intake Packet

Intake Packet in Spanish

Intake packet in Hmong

 

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