Patient Forms
Want to save time during your visit with us? Please print and fill out the following forms and bring with you on your first appointment. ( To print, select the form so it opens up on your computer, once document form is open, select the print option).
Patient Information Form (Spanish)
Patient Information - Spanish.pdf
Adobe Acrobat document [89.7 KB]
Patient Information - Spanish.pdf
Adobe Acrobat document [89.7 KB]
Patient Acknowledgement of the Notice of Privacy Practices & Consent to use & Disclose Health Information
Patient Acknowledgement.pdf
Adobe Acrobat document [35.2 KB]
Patient Acknowledgement.pdf
Adobe Acrobat document [35.2 KB]
Notice to Patients To Charge for Missing Appointments
Notice to Patients Charge for missing ap[...]
Adobe Acrobat document [35.9 KB]
Notice to Patients Charge for missing ap[...]
Adobe Acrobat document [35.9 KB]
Patient Request to Change Medication
If you as a patient are looking to change medication, you must complete and sign this form
Medication change.pdf
Adobe Acrobat document [49.1 KB]
If you as a patient are looking to change medication, you must complete and sign this form
Medication change.pdf
Adobe Acrobat document [49.1 KB]
Optional Forms (Symptoms or Illness)
The following Forms are to be filled out if you feel you may have some of the symptoms that could classify you as having this ailment or sickness.
Mood Disorder Questionaire (Spanish)
Mood Disorder Questionaire - spanish.pdf
Adobe Acrobat document [107.8 KB]
Mood Disorder Questionaire - spanish.pdf
Adobe Acrobat document [107.8 KB]
Patient Health Questionaire (PHQ-9)
Patient Health Questionnaire.pdf
Adobe Acrobat document [38.5 KB]
Patient Health Questionnaire.pdf
Adobe Acrobat document [38.5 KB]
The Generalized Anxiety Disorder 7-Item Scale (GAD-7)
GAD-7 Scale.pdf
Adobe Acrobat document [27.9 KB]
GAD-7 Scale.pdf
Adobe Acrobat document [27.9 KB]
Don't forget to bring your insurance information with you
In order to register and treat you promptly, we request that our patients bring their current insurance information with them for each visit.
We accept most types of health insurance. Please contact us for further details.
Important telephone numbers for in case of emergencies:
| Organization | Telephone Number |
| Emergency Services & Fire Department | 911 |
| Centers for Disease Control and Prevention | 800-CDC-INFO (800-232-4636) |
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