If you're a first-time client, please review and complete the following forms. Please scan or fax 24 hours prior to your scheduled intake. Fax 888.910.0622.
- Credit Card Authorization Form (required to be faxed in advance of initial appointment for all clients, incl. cash paying clients)
- Cancellation Policy Form (required by fax in advance of initial appointment)
- Insurance Information Form and Third Party Payment Information (required for all clients requesting SUPERBILLS for insurance submission, all clients who are requesting payment from a source other than themselves)
- ADULT Neurotransmitter and Health Assessment Questionnaire (NTAF - to be filled out by clients with mood concerns)
- CHILD Neurotransmitter and Nutrition Assessment Questionnaire (to be filled out by parents)
- Symptom Assessment (initial and follow up assessment form)
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