Download the intake forms below and fill them out before your first appointment. Forms can be sent electronically to firstname.lastname@example.org. Scanned or photographed copies will be accepted at this time.
Please include the patient name in the body of the email so they can be properly loaded into our electronic health record.
This will speed up the paperwork process so we can get to know you better at your first visit.
- Your chief complaint and symptoms
- Any current and past health issues, allergies, and medications
- Current and past therapy treatments you have obtained
- Current and past family and social support systems
- Current and past personal and family drug and alcohol use