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CLINIC FORMS

Intake Form

A completed intake packet and a copy of insurance cards are required prior to being scheduled for services.

Please fill out the paperwork below or contact the office to provide information so intake documents can be sent through our EHR.

Please call the front desk if you have any questions.

Release of Information

This form is used to release your protected health information as required by federal and state privacy laws. Your authorization allows The Clinic to release your protected health information to a person or organization that you choose.

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