DOWNLOAD forms and policies

INTAKE FORMS

INCLUDING CONSENT TO TREAT AND OFFICE POLICIES

(Completed prior to your first visit)

SLIDING FEE SCALE APPLICATION

(Discounted Services based on Income and Family Size) 

THIRD-PARTY PAYER SIGNATURE FORM

(Other entity agrees to pay for your services;  i.e. friend, family, or church) 

NON-DISCRIMINATION POLICY

AUTHORIZATION FORM ACH CREDIT CARD RECURRING PAYMENT