Forms

Please click the appropriate links and download the forms applicable to you. You can fill them out electronically or print them out to complete them. Please bring them completed to your appointment.  By completing these forms prior to your intake appointment, you will save valuable time during your visit. Furthermore, if you have any questions when filling out these forms, please fill out as much as you can and we will gladly assist you with your questions on the day of your visit.

 

**If you are filling out these forms on behalf of your child, please download and complete the Child Intake Packet. If you are filling out these forms on behalf of yourself, please download and complete the Adult Intake Packet.

 

INTAKE PACKETS:

Child/Adolescent Intake Packet 

History, Consent for Treatment, HIPAA, Patient Payment Responsibility

Adult Intake Packet

History, Consent for Treatment, HIPAA, Patient Payment Responsibility

ADDITIONAL FORMS:

Patient Release of Information

             

Credit Card Authorization

 

Health.Hope.Healing.

10205 South Dixie Highway

Suite 203-204

Pinecrest, FL  33156

Call Us: (305) 662-2686

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