INSTRUCTIONS: If you have access to a printer, click this link, print, complete and sign:

  • Patient Information
  •  Authorization To use Or Disclose Protected Health Information
  •  Office Policy Regarding Insurance and Payment
  •  Privacy Policy Acknowledgement

Bring these with you to your first visit. If you cannot download and print, I will provide a packet of forms for you when we meet. If there is any part you are unsure how to answer, I will help you at that time.

 

PC users will need Adobe Acrobat or Adobe Acrobat Reader to open and print the Intake Forms. Mac users can view the intake Forms with either their Preview application or Acrobat Reader.

Click here to download a free copy of Adobe Acrobat Reader.