Forms

It will be an honor to work with you.
Prior to your first appointment, please download, print, and fill out the following forms. Please bring the completed forms to your first appointment.

Adult patients (18 and up):

1. Adult Registration Form
2. Adult History Form
3. HIPAA
4. Confidentiality
5.Consent for release of info (if applicable, to speak with another healthcare professional)
6. Patient Information Regarding Fees

Child patients (3-12):

1. Child Registration Form
2. Child History Form
3. HIPAA
4. Confidentiality
5. Consent for release of info (if applicable, to speak with another healthcare professional)
6. Patient Information Regarding Fees

Teen patients (13-17):

1.Child Registration Form
2. Adolescent History Form – Self Report
3. HIPAA
4. Confidentiality
5. Consent for release of info (if applicable, to speak with another healthcare professional)
6. Adolescent History Form (parent report form)
7. Patient Information Regarding Fees

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