We have created links to the intake forms we will need completed prior to being seen on your first visit. Filling these out in advance will save you time prior to being seen by your therapist.

You can complete through a HIPAA secure online platform on your computer, tablet, or smart phone by clicking the link below:

New Patient Intake Packet

Secure Online Forms Powered by MedForward ®

Our forms are also available for print and fill out prior to your visit. If you need a free PDF reader, click Free Adobe PDF Reader.

  1. Intake —Medical History
  2. Intake — Patient Intake Form
  3. Intake — Consent for Treatment Form
  4. Medicare Questionnaire (Please only fill this out if Medicare is a primary or secondary insurance)
  5. Privacy Policy — HIPAA (Please read, not necessary to print)

 

Make an appointment today! Call (603) 537-1700