Patient Forms

Forms & What to Bring 

Please download, print, and complete the following forms prior to our first appointment.

1) Consent to Treatment Form

Consent to Treat

2) Email Authorization Form

Email Auth

3) Financial Responsibility Form

Financial Responsibility Form

4) Notice of Privacy Act

Notice of Privacy Act

5) Privacy Act

Privacy Act

6) Release of Information Form – This form allows clinicians to contact third parties such as, physicians, teachers, etc.

Release of Information

7) If applicable, please bring a copy of patient’s insurance card.

8) Please bring copies of previous records (i.e., copies of previous assessments, relevant medical records, grade reports etc).