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Interracial Couple

Forms For Your Initial Visit

 

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 bring with you 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 bring with you 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 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.

 

Note: To download Adobe Acrobat Reader for free, click here

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Helpful Forms

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