Forms

Our Forms

Please click the corresponding link to view the form.

SIGNATURE FORM TO COMPLETE PRIOR TO FIRST APPOINTMENT
This form may be completed online by the link above or you can download the form or print it here.

INTAKE FORM TO COMPLETE PRIOR TO FIRST APPOINTMENT
This form may be completed online by the link above or you can download the form or print it here.

 

The below additional forms are to view but NOT to be completed on line (click on each link):

Consent for Treatment

Treatment Policies

HIPAA and Notice of Privacy Practices

Credit Card Processing with Ivy Pay

Release of Information

No Surprises Act (2022)

Parentheses, 2015: Joshua Meyer, 40×36 inches, oil on canvas, 2015