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Clinic Forms

Intake Form

A completed intake packet and a copy of your insurance cards are required before we can schedule your services.

Please contact the office to have the intake documents sent directly to you through our patient portal. Alternatively, you can print the intake paperwork below, complete it, and return it to The Clinic to schedule your appointment.

Please contact the front desk with any questions.

Release of Information

This form authorizes The Clinic to share your protected health information with a person or organization you specify, in accordance with federal and state privacy laws.

If you would like to receive the form through the patient portal, please contact the office.

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