New Patient Forms
NEW PATIENTS MUST COMPLETE ALL THE NEW PATIENT FORMS
What if I don’t have a Primary Care Physician (PCP)?
We still need this form submitted – just check the box “I do not have a PCP”.
Please make sure you sign, date and submit all your forms.
A prompt will let you know that the forms have been submitted properly.
We look forward to seeing you!
PLEASE SUBMIT THE FORMS ELECTRONICALLY
It is important to electronically “submit” the forms instead of printing them yourself. If you print them and bring them in, it may result in having to to re-do the forms. These forms are a legal requirement in order to be seen as a patient at this practice.
All patients must complete all the New Patient intake forms prior to their preliminary evaluation.
How do I sign the online forms?
You can use a mouse to sign or your finger when signing on a mobile device, or track-pad enabled device (laptop, tablet).
If you don’t like your signature, just click ‘clear’ and try again.
Can I use initials, an ‘X’ or a line as a signature?
YES!! Your signature doesn’t need to be pretty or just something to indicate you ‘signed’ the document. See the examples provided
new patient Forms – please fill out and submit all forms
- Patient Information Sheet – (All new patients must complete)
- Primary Care Physician (PCP) Release – (All new patients must complete)
- General Release – (Please complete if you are being treated by any additional specialist and would like us to share information)
- Pharmacy Intake Form (All new patients seeing a MEDICAL provider must complete)
- Patient Intake Questionnaire – (All new patients must complete)
- Financial Agreement and Worker’s Compensation/No Fault – (All new patients must complete)
- PHQ-9 Form – (All new patients must complete)
- Privacy Notice and Confidentiality Agreement – (All new patients must complete)
- Consent for Treatment – (All new patients must complete)
- Photo ID and Insurance Card Submission – (All new patients must complete)