Forms

Please print and fill out the Registration / Intake Information form and the Privacy Notice & Consent to Treatment form. You will need to bring all documents with you along with your insurance card to the initial appointment. We accept cash or check at this time for your insurance co-pays or self-pay.

I look forward to meeting you at our initial session.

Please download and complete for the first visit:

Registration Intake Information Form (.pdf)

Privacy Notice & Consent to Treat (.pdf)

Insurance Verification (.pdf)

Office Policy- Financial & Billing Agreement (.pdf)

Release of Confidential Information (PHI) (.pdf)