Clinic Forms & Waivers

If you are a physician and referring a new patient, please complete and fax the referral form, along with any applicable evaluation/procedures, recent office notes, hospital/rehab notes and/or specialty visits related to diagnosis. 

Physician Referral Form

This form is to be completed by the referring agency or physician, most commonly your Primary Care Physician.

Maroon background with white text that reads "Child Intake Form" and a faint abstract leaf design.

Please complete this intake for children under the age of 18.

Maroon background with white text that reads "Adolescence & Adult Intake Form" and a faint abstract leaf design.

Please complete this intake form for adults and adolescence over the age of 18.