Our forms are available online for your convenience! We recommend you use a phone or tablet, as it will be easier to provide pictures of photo ID, insurance cards, etc.
New Clients: Please fill out the New Client Intake and Credit/Debit Card on File Authorization forms below. There are different forms for adults and minor children.
Current Clients: Forms are available for you to update your Credit/Debit Card on File, and Insurance Information.
New Clients – Adults
New Client Intake Form (Adults) – must be completed by the client
Payment Authorization – Credit/Debit Card on File – must be completed by the cardholder
New Clients – Minor Children
New Client Intake Form (Minor Child) – must be completed by the responsible party (a parent or guardian)
Payment Authorization – Credit/Debit Card on File – must be completed by the cardholder
Current Clients
Payment Authorization – Credit/Debit Card on File – to add or replace an existing credit/debit card on file, must be completed by the cardholder
Update Insurance Information – must be completed and signed by the client or responsible party (a parent or guardian)
