Forms

On Line Forms Instructions
           (Preferred)

For convenience I am now using an online portal for the required forms.  When I set up my first appointment with you, I will start a profile for you on my Theranest site.  You will be sent an email that will provide a link for you to get started on that site.  There will be some information you will need to provide and many of the forms will be simply ones you read and electronically sign your agreement.

     Print & Fill Instructions
​               (Optional)

If you prefer to not use the on line portal, you may opt to print, fill, and sign the required forms.  Should you desire this method, click on the forms below,  print, fill out if required, and provide signatures and dates as requested that you understand what you signed.   

client_history.pdf
File Size:	3494 kb
File Type:	pdf

Download File

---

client_registration.pdf
File Size:	1024 kb
File Type:	pdf

Download File

---

ebc_informed_consent.docx
File Size:	236 kb
File Type:	docx

Download File

---

ebc_hipaa_notice.docx
File Size:	217 kb
File Type:	docx

Download File

---

practice_policies.docx
File Size:	218 kb
File Type:	docx

Download File

---

electronic_communication_addendum.pdf
File Size:	46 kb
File Type:	pdf

Download File

---