New Patient Registration Forms

Thank you for your interest in working with one of our clinicians.

Please complete our online new-patient paperwork as soon as possible and no later than 24 hours prior to your appointment.  It is important that we have all information and documents on file in order to set-up up your patient chart and to determine insurance benefits.

 

We ask you to complete the following 3 forms. Please have a picture ID and your insurance card available before you begin to complete the registration; you will be able to take a picture and upload the documents.

 

Please return to this web site after you have completed each form to fill out the next one.  

 

1. New Patient Paperwork

1.1  Additional Pages Required for Substance Abuse Treatment Services

 

2. Health Screeners

 

3. Primary Care Provider Care Coordination Authorization

 

OPTIONAL:

4. Additional ID documents OR Additional Insurance Cards (or updates)

 

If you are requesting a mental health or psychological evaluation from our agency and have been court-ordered, please submit your court order below.

Submit only the relevant pages that help us understand your need for services and to assist us with planning your evaluation in order to meet the requesting party's order (i.e., judge, parole officer, etc.).

 

5. Submit Court or Referral Order by clicking on this link.

 

If you have any questions, please call our office at 239-3677.

 

We are looking forward to your visit.