Patient Information


Like all medical providers we will need you to fill out paperwork before the therapist can evaluate and treat you.  This paperwork consist of personal and demographic information, information about the condition we are seeing you for and payment (insurance) information.  We will (have) asked many of these questions when you set up your first appointment.  That is so we can schedule you with the right therapist and make arrangements with your insurance provider.  We will ask you those questions again, in written form to help eliminate human error on our part by taking information over the phone.

You are welcome to fill out this paperwork in the clinic.  Please arrive 15-20 minutes early to do so.  You may also print these forms, fill them out at your convenience and bring them with you to save that 15-20 minutes in the clinic.

Intake Form Please fill out this form as completely as possible.  You may need information from your spouse, employer or insurance company.
Formulario de admisión en español Por favor llene este formulario lo más completo posible. Es posible que necesite información de su cónyuge, empleador o compañía de seguros.
Condition of Treatment This document defines the financial relationship between you and us and other policies that you should be aware of and agree to before we treat you. Please read, sign and bring with you to your first visit.
HIPPA This document outlines how we will handle the privacy of your personal information in accordance with state and federal laws.  Please read, sign and bring with you on your first visit.

There may be other paperwork to fill out base on your individual circumstances.

Thank you for choosing us!  We look forward to seeing you.