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Forms

English Forms

All forms in English : Intake, Consent, Rights & Responsibilities, etc. Both Printable and Digital.

Spanish Forms

Para los pacientes que forman parte de nuestra comunidad de habla hispana, envíenos un correo electrónico para obtener más instrucciones sobre cómo programarse. Un traductor puede estar disponible para usted si lo solicita.

Forms: Files

English  Forms

Forms: Text
Forms: Files

Intake includes all required materials for Standard Evaluation.

Intake Adult

Intake Adolescent

   (17 & under)

Intake Child (13 & Under)

Speciality Evaluations

These are required in addition to the INTAKE forms above.

Bariatric

Pre-Surgical Evaluations

Pain

(Substance Abuse)

Pain Pre-Surgical Evaluations

(e.g., Spinal Cord Stimulator)

Forms: Files

Separate copies of selected forms that are included in the intake materials are below.

General Medical

Release

Primary Care Physician Release

Psychiatrist Release

HIPPA Consent

Non-Discrimination Statement

Telehealth Consent / Social Media

Forms: Files

Employee Assistance Program

ADVANTAGE EAP Intake Forms

Adult Forms

Adolescent Forms

Child Forms

File Title

Download
Forms: Files
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