CREDIT CARD
&
BILLING AUTHORIZATION

Complete this form to place a credit card on file for billing purposes

HIPPA PRIVACY POLICY

Review the HIPPA privacy policy, and acknowledge acceptance.

RELEASE FOR APPOINTMENT REMINDERS
INITIAL PATIENT INTAKE FORM

This form contains information we require in order to provide service

POLICIES

This document informs clients of our policies

Complete this release form to receive appointment reminders from us

RELEASE FOR APPOINTMENT REMINDERS
RELEASE FOR ELECTRONIC INVOICE

Complete this release form to enable electronic invoicing