For your convenience, we have made a number of forms available for new clients to download or to submit online. Filling these out in advance of your first visit will minimize the time you spend in the waiting room.

Office Policies

• Revised Policies 2017-2018 available upon request

FOR OFFICE USE ONLY:

• Verification Form

• COVID Supplemental Consent Form

• E-Form for Face to Face and TeleHealth Services

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To Print or do online at the office request. Forms filled out in advance will not be accepted.

• Client Intake Form

• Client Ins. Policy

• Life History Questionnaire

• Informed Consent

• Self-Paying Clients:

• Fee for Service Form

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Please feel free to call them Proclaim Medical office Billing: 888-559-1119.