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 or you can ask us to send you a link to submit directly on the Fusion patient portal 

Terms of service TEIS Version.pdf
Terms of service Non-TEIS version.pdf
STAR Outside Service Liability Release.pdf
photo release.pdf
PARTICIPANT release of liability updated 4 2021.pdf
HP release of info updated 2020.pdf
HP COVID release 2020.pdf
fillable HIPPA release 12-15-22.pdf
fillable CC authorization form 12-15-22.pdf
Assignment and Release of Benefits working1.pdf