First fax the COMPLETED forms to the fax number provided on the top right hand corner of the forms. Then please bring the COMPLETED forms to your first appointment (Select one below.)

1. New Patient History Form
2. Fees
3. Notice of Privacy Practices
4. Patient Services Agreement
5. Medicare/Medicaid Statement
6. HIPAA Statement and Patients Rights
7. Controlled Substance Medication Agreement
8. Follow Up Appointment Policy

 

Fill out the Authorization to Disclose form if we request this later

9. Authorization to Disclose Protected Medical Information-For us to obtain records from your last psychiatrist or any physician treating you for a psychiatric issue (including ADHD).