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Patient Information

Clinical Patient Forms

Below are assorted forms that patients at our practices fill out upon entry or re-entry into our program.  If you have never been to one of sites before but are in need of help, please call either our toll free hotline 1-800-770-1904 or contact any of our sites directly and our friendly staff will assist you.  Once you have an appointment, you can print out the New Patient Packet below (or Returning Patient Packet if you have seen us before more than 3 months ago).  This will save you some time at your visit and will enable you to be seen quicker.  You can always call the site you have an appointment with if you have any questions.

 


Pain Assessment (if applicable) (Requires Microsoft Word to view.)
Returning patient packetIf you have been to one of our offices before but have not had a visit for more than 4 months, you can fill this out before your restart visit to save time on the day of service. (Requires Microsoft Word to view.)
Past Drug Use (if applicable) (Requires Microsoft Word to view.)
Anxiety rating scale (if applicable) (Requires Microsoft Word to view.)
New Patient PacketIf you have never been to one of our offices before and have made an appointment for you first visit, you can print this out and complete it at home to save time on your first visit. (Requires Microsoft Word to view.)
Health history (Requires Microsoft Word to view.)
Health Perceptions (Requires Microsoft Word to view.)
Release of Confidential Information (Requires Microsoft Word to view.)
FAQs (Requires Microsoft Word to view.)
Patient Privacy Practices (Requires Microsoft Word to view.)