To Schedule An Appointment
or email: firstname.lastname@example.org
Live in Perfect Balance!
Please download and fill out the following new patient forms.You only need to download the forms under "New Patient Intake Forms". The other two are for informational purposes only.
To best utilize the time you have with your therapist during the evaluation, please complete these forms prior to your visit and bring them with you. A single document will download with all the forms included.
For your reference the Inclement Weather Policy and HIPPA Notice of Protected Health Policies are also available on the link below. Please review these policies before you sign the Inclement Weather Policy and HIPPA Release.
If you have any trouble printing these forms or any questions while filling them out your therapist will be happy to help you with them during the evaluation.
New Patient Intake Forms
One 6-page document will download with all five forms included. The forms are:
1-page General Information form
2-page Health History
1-page HIPPA Release/Financial Policy
1-page Consent for Use of Protected Health Information
1-page Snow/Weather Cancellation Policy
Inclement Weather Policy
You do not need to print this. This is a copy of the policy
Notice of Protected Health Policy
You do not need to print this. It is for your informaitonal purposes only.