Forms

Intake Forms: All Forms are encrypted and meet the privacy standards for HIPAA

All new patients fill out the 3 electronic forms below and print out the signature form and sign it. The HIPAA document is for your personal files.

INTAKE AND MIND-HEALTH ANALYSIS FORM

https://goo.gl/forms/4cGgyn0cbpziivgL2 

 

LEGAL FORM: TREATMENT FORM AND CARE AGREEMENT: 

https://forms.gle/j3x1zXKBvWmH5izW6

 

CREDIT/DEBIT CARD POLICY AND PAYMENT AGREEMENT:

https://forms.gle/T2WpC3aUfUncUdFG6

 

DIRECTIONS TO OUR OFFICE: PLEASE READ getting to our office can be tricky the first time. 

Intake documents
Session 2 Documents
Prescription Refill Backup Form

Prescription Refill Backup Form

https://forms.gle/jXnfU7Y8sjF8LX9s8

INTAKE SIGNATURE FORM

(please click on the link below and download it to your computer to print out and sign. You may fax this document to: 855-808-4055 or bring with you to your next appointment):

Intake Legal Signature Document

OFFICIAL OFFICE HIPAA DOCUMENTATION

(please download and keep for your own records):

HIPAA Notice of Privacy Practices