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Interracial Couple

Forms For Your Initial Visit

If you have made an appointment, you should have been emailed a link to our patient portal. If you did not receive the link invitation email, please check your spam folder or call the office for another emailed link.

If you did not elect to provide your email then please continue and complete the appropriate forms below and deliver, mail or fax them at least 3 business days prior to your initial appointment. Failure to do so may result in your appointment being cancelled or rescheduled.

Please review choices and choose forms below:

Adult Clients:

Print and complete all Adult Client Information Sheets and print only the signature page of the Service Agreement for your signature and deliver, mail or fax them to us at least 3 business days prior to your initial appointment.

If appointment is for couples, please complete one set for each adult.

 

Child Clients under 18 years old:

Print and complete all Child Client Information Sheets and print only the signature page of the Service Agreement for your signature and deliver, mail or fax them to us at least 3 days prior to your initial appointment. (Children do not attend first consultation.)

Please note: If parents are divorced or separated, both parents must each complete a set of these forms. If one parent is out of the area, these forms may be faxed or mailed to our office at least 3 business days prior to the appointment. If you have any questions, please call our office and speak with our staff.

 

Other helpful forms:

If you have Medicare, please review and sign the Medicare Private Agreement and bring with you to your initial appointment.

Release of Protected Health Information.

 

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Helpful Forms

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