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FORMS

Required Documentation

These five electronic forms, listed below, must be completed prior to your first evaluation. Please take the next 8-15 minutes to fill out the forms below.

Click on the hyperlinks below or (CTRL+click each link) to open up multiple windows.

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New Patient Registration Form

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Health Intake Form

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Informed Consent for Treatment

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Patient Notification & Privacy Policy

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Cancellation & Attendance Policy

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If these forms are not completed prior to the evaluation, it may take away from your allotted evaluation and treatment time. Please take the time to fill them out prior to our initial visit. Thank you!

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Forms: About

NEW PATIENT REGISTRATION FORM

Basic information to help me connect and with you.

Programs Not Covered:   Medicare/Medicaid,  Worker's Compensation,  Motor Vehicle Accident

Forms: About Us

HEALTH INTAKE FORM

Information that will help me formulate your plan of care.

Forms: About

INFORMED CONSENT FOR TREATMENT FORM

Please read all information prior to your episode of care.

Forms: About

PATIENT NOTIFICATION & PRIVACY POLICY

Privacy Policy and HIPAA Information.

Forms: About

CANCELLATION & ATTENDANCE POLICY

Expectations on attendance and procedure for cancellation.

Forms: About
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