Switch to Accessible Site
TransformationStarts With You
Woman Being Free

New Patient Forms

PLEASE DOWNLOAD, COMPLETE/SIGN ALL FORMS LISTED BELOW (WITH THE EXCEPTION OF THE EMOTIONAL SUPPORT ANIMAL/ESA EVALAUTION PACKET UNLESS YOU ARE AN ESA PATIENT) AND BRING THEM WITH YOU TO YOUR INITIAL APPOINTMENT.  THIS MUST BE DONE PRIOR TO BEING SEEN UNLESS EXTENUATING CIRCUMSTANCES HAVE BEEN DISCUSSED BEFOREHAND.  

THANK YOU!

Welcome Informed Consent Form

 

Missed/Late Cancel Policy Form

 

ESA Psychological Evaluation Form

 

Demographic Face Sheet


HIPAA Confidentiality Form


Notice of Privacy Practices



Adult Patient History Form
 


Authorization To Disclose Information

 


Note: To download Adobe Acrobat Reader for free, click here.

 

Schedule Appointment

Start your new path in life and be the change today!

Click Here
Helpful Forms

Click here to view and print forms for your appointment.

Click Here