Insurance Card Submission: you are required to send us an updated copy of insurance in order to file a claim for any appointments

Photo ID Submission

TelePsych Agreement

Authorization to Disclose – Release of Medical Records Form

Notice of Privacy Practices

If you have any changes to your demographics please fill out our established patient update form:

Established Patient Form – Adult

Established Patient Form – Child

New Patients please fill out either the child/adult new patient form as well as submit a photo ID, insurance card, telehealth agreement and if needed a release of medical records form:

New Patient Form – Adult

New Patient Form – Child / Adolescent