Clinic Forms

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Cancellation & No-Show Policy (pdf)

Consent for Treatment (pdf)

Credit Card Authorization Form (pdf)

Financial Agreement & Payment Policy (pdf)

HIPAA Notice of Privacy (pdf)

History (pdf)

Intake form (pdf)

Notification of Insurance Change (pdf)

Parent Satisfaction Survey (pdf)

Photo & Video Consent Form (pdf)

Release of Information (pdf)

Referral Form (pdf)