Intake Form Packet (PDF)A packet of information and forms to be completed by new clients.

This packet contains the following forms:

  • Authorization for Treatment
  • Clinic Policies and Procedures
  • Confidentiality Policy
  • Emergency Contact Form
  • Financial Responsibility Form
  • HIPPA Notice/Acknowledgement
  • Information Release
  • Photo Release
  • Release for Educational and Teaching Purposes

This packet is provided in Adobe PDF format (Portable Document Format) which allows higher quality print output. To open this file you will need Adobe Reader software installed on your computer. If you do not have the Adobe Reader software already installed on your computer you can download the installer and instructions for free at the Adobe Website.