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Patient Forms

Getting Started

New Patients

Please review the information below and download your forms before your first visit to help us make the most of your appointment time.

What to Expect at Your First Visit

The first visit will largely be information gathering and covering what the first treatment steps will be. Expect the visit to take up to 90 minutes.

To more efficiently use our time together, we ask that all new members bring your photo ID and insurance card(s). We also ask that you arrive at least 30 minutes early.

1
Download Forms

Download and print the required new patient forms listed below before your appointment.

2
Complete at Home

Fill out all forms completely and accurately. This saves valuable time during your visit.

3
Arrive 30 Min Early

Bring your completed forms, photo ID, and insurance card(s) and arrive 30 minutes before your scheduled time.

4
Your First Visit

Your first visit will focus on information gathering and outlining your personalized treatment plan. Plan for up to 90 minutes.

Downloads

Patient Forms & Documents

Click the Download button on each form. Print, complete, and bring all forms to your first appointment.

Adult FOC Intake Form

Required for all new adult patients general intake and medical history

Download PDF
Privacy Practice Summary

Notice of Privacy Practices (HIPAA) summary document

Download PDF
Privacy Practices Update 2020

Updated Notice of Privacy Practices 2020 revision

Download PDF
Financially Responsible Party

Financial responsibility and billing agreement form

Download PDF
Records Release Northshore

Authorization to release medical records form

Download PDF

Ready to Schedule Your First Visit?

Call our office today or request an appointment online. Our compassionate team is here to help you take the first step toward recovery.