FORMS
Being given an appointment does NOT automatically mean you are
accepted as a patient of this practice. The first appointment and
agreement between the patient and provider must follow.
new clients: please read and sign a copy of the agreement below.
* Telemedicine patients cannot be seen until we recieve the originating paperwork
as advised on your phone interview.
Please download and fill out the forms below before your first office visit if at all possible to save time ...
New Mental Health Patients : 1st 6 files, the inventories at the right are helpful but not required unless requested.
* any overlap in the questions on the forms need only be answered once.
Buprenorphine/ Suboxone patients , may add the bottom group.
New Mental Health Patients : 1st 6 files, the inventories at the right are helpful but not required unless requested.
* any overlap in the questions on the forms need only be answered once.
Buprenorphine/ Suboxone patients , may add the bottom group.
| new_pt__1_.pdf |
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| patient_agreement_rev_2020_000055.pdf |
| telepsychiatry_consent.pdf |
| medical_history_copy1__1_.pdf |
| mental_health_intake_form.pdf |
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| consent_to_release_of_confidential_info.pdf |
SUBOXONE SPECIFIC DOWNLOADS
| img_suboxone_treatment-agreement_copy.pdf |
| buprenorphine_maintenance_treatment.pdf |
| new_suboxone_patient_info.pdf |