Registration Forms

Patient Information Form (PDF - 2161k)

Includes terms and conditions of treatment (3 pages)

 

Privacy Notice (PDF - 2982k)

Individually identifiable health information (2 pages)

 

Privacy Notice Acknowledgment (PDF - 435k)

Acknowledgment of receipt (1 page)

Authorization Forms

Authorization for Release of Information Form (PDF - 1520k)

Authorizes release of protected information(1 page)

 

Informed Consent for In-Person Service Forms          

COVID-19 Health Crisis (2 pages)