Patient Forms
HIPPA Notice of Privacy Practices
No signature required, please review as part of HIPPA policy
HIPPA Compliance Patient Consent Form
Please download, read and sign
Patient Consent to Treatment Form
Please download, read and sign
New Patient Intake Form
Please download, read and sign
Demographic Form
Please download, fill out, read and sign
Authorization for Release of Information
Please download, read and sign
Patient Financial, Rescheduling Policy
Please download, read and sign
Medicare Private Contract
Please download, read and sign
CBD THC-A Treatment Progress Log
Please bring your log with you on your follow up visits, or have them available during teleconferences
Opioid Risks and Benefits
No signature required, please review
Opioid Use Agreement
Please download, read and sign
Forms for Physician/Clinic Use
For the forms below, please download, read and bring to your appointment (do not sign)
Consent for Trigger Point Injection
If you have any questions about registration or signing forms, please do not hesitate to contact us.