Intake Forms

ID & Insurance

• ID & Insurance Card

New Patient/Updated Patient Intake

• New Patient/Updated Patient Intake Form
• Medication & Psychotherapy Consent Form

Patient Health

• Patient Health Questionnaire

Credit Card Payment Authorization

• Credit Card Payment Authorization Form
• Payment Plan Authorization Form

ROI

• ROI Form

Ketamine

• Consent for Ketamine Treatment – Patient
• Consent for Ketamine Treatment – Physician
• Patient Health Questionnaire
• Ketamine Treatment Information

Health and Wellness Coaching

• Wellness Coaching Client Agreement
• Wellness Coaching Scope of Practice Form