For current clients, new clients, and/or parent/guardian responsible parties.
To help keep clinical and administrative records current, clients may be asked to review and complete updated paperwork. For current clients, this is an administrative update and does not mean that treatment is starting over.
Please review each section carefully before submitting the form. You may contact the office with questions about any policy before signing.
This form is not monitored for emergencies. If you are experiencing an emergency, call 911 or go to the nearest emergency room.
Do not enter a complete credit card number, expiration date, or CVV anywhere in this form. Payment information must be provided through the practice’s secure payment system or directly to the office.
