New Patient Forms

Below are the required consents that must be completed and returned to our office BEFORE we can schedule an intake appointment for yourself or your child. Please be aware that the Consent for Recording requires you to choose what you are consenting to. If you consent to recording, DO NOT initial option #4 as that will invalidate the consent.

Please print, complete and be sure that all applicable signatures are signed and dated. If both parents have medical rights, then both parents must sign the consent forms. If you are the guardian, we will need court paperwork indicating that you are the guardian and have medical rights. If both parents do not sign and have rights, we will not be able to provide services until both have consented. Forms can be signed individually by each parent/guardian, but all must be received by our office.

A Release of Information form should be completed for any providers you include on the Provider Medical Record List. Please be sure to check each box you are allowing us to obtain information for/release information to and sign and date the form or the form will be invalid and will slow down the process.

The Credit Card Authorization Form is an optional form. Often, insurance policies have co-payments associated with certain types of service. Before we charge your card, we will request from you approval to charge your card on file and the amount to be charged. You can also approve payment for any potential deductible amounts to this card.

Please return these forms via U.S. Post Office or drop off at our office. If you prefer to e-mail them, please connect with us so we may send you a secure e-mail to attach the signed files to.

We will also send you the Payment Contract, which is specific to you and your insurance at the time we verify your insurance. Costs could change if you have met your deductible, or a portion of your deducible, if applicable, before your appointment.

Please be aware that the testing process does take some time, but we strive to have your testing and report completed as soon as possible.

If you have any questions, please feel free to contact our office.

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