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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

Intake includes all required materials for Standard Evaluation.

Intake Adult

Intake Adolescent

Intake Child (13 & Under)

Forms: Files

Special Evaluation forms for pain-related referrals are below. These are required in addition to the INTAKE forms above.


(Substance Abuse)

Pain Stimulator

(e.g., Spinal Cord Stimulator)

Forms: Files

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


General Medical Release

HIPPA Consent


Non-Discrimination Statement


Telehealth Consent / Social Media




Forms: Files

Advantage EAP (Employee Assistance Program)



Rights and Responsibilities


Forms: Files
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