Patient Paperwork
New Patient Paperwork
New Patient paperwork can be filled out and signed digitally: Click the button below and follow the simple instructions to fill out your new patient packet
Telemedicine Consent Form
This consent form is for patients that are using our Telemedicine Services for remote medical care
Release of Records Request Form
This form is used to request your private health records from your previous provider or from recent hospital visits
Buprenorphine (Suboxone/Subutex) Consent Form
This form outlines our policy for patients who are taking buprenorphine
Depression Screening Brief Survey
This is a tool that is used by patients and interpreted by your provider in order to screen for depression
PREGNANT PATIENT Office Based Addiction Therapy
This is a Consent Form for Office Based Addiction Therapy (OBAT) if you are Pregnant.
DAST Screening Test
This is a Form to Complete for your DAST Screening Test if your Provider requests it.
To refer a patient, please fill out the form below. If you have any questions, feel free to contact us.
