Client intake forms
Please complete all forms prior to your first scheduled session, as well as a copy of your insurance card, insurance holder's driver's license. These can be emailed to office@heightenedpotential.com or you can ask us to send you a link to submit directly on the Fusion patient portal
Please complete all forms prior to your first scheduled session, as well as a copy of your insurance card, insurance holder's driver's license. These can be emailed to office@heightenedpotential.com or you can ask us to send you a link to submit directly on the Fusion patient portal
Terms of service TEIS Version.pdfTerms of service Non-TEIS version.pdfSTAR Outside Service Liability Release.pdfphoto release.pdfPARTICIPANT release of liability updated 4 2021.pdfHP release of info updated 2020.pdfHP COVID release 2020.pdffillable HIPPA release 12-15-22.pdffillable CC authorization form 12-15-22.pdfAssignment and Release of Benefits working1.pdf