If you're a new patient, please complete the following forms and bring them to your first appointment.
ADULT NEW PATIENT PACKET
CHILD/ADOLESCENT NEW PATIENT PACKET
If you would like for us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.),
complete this form to authorize release of protected health information:
AUTHORIZATION TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION
If you are interested in referring a patient (or yourself) to our practice, please complete the following form and fax to our office at 919-787-1938. You can also e-mail the form to: firstname.lastname@example.org. Patients who have already scheduled a new patient appointment with our office do not need to fill out this form.
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