**NEW PATIENT PAPERWORK** -
**All new patients must complete this paperwork and submit it to the office before your appointment.**
**You can complete by digital signature and digital submission by clicking here** **New Patient Paperwork** **or by PDF by clicking the paper/pencil icon.**

Questionnaires — **QUESTIONNAIRE for MEDICATION MANAGEMENT -**
**Please complete and bring with you to your first session if you are being evaluated by a prescriber for medications.**

**CONTROLLED SUBSTANCE AGREEMENT** -
**Please complete and bring with you to your first session if you are being evaluated by a prescriber for medications.**
**You can complete by digital signature and digital submission by clicking here** **Controlled Substance Agreement** **or by PDF by clicking on the paper icon.**

PATIENT INTAKE FORM — **ADULT HISTORY INTAKE FORM -**
**Please complete and bring with you to your first session.**

CHILD INTAKE FORM — **CHILD HISTORY INTAKE FORM -**
**Please complete and bring with you to your first session.**

COUPLES INTAKE FORM — **COUPLES HISTORY INTAKE FORM -**
**Please complete and bring with you to your first session.**

Medication Refill Request - Please either complete the form here or give us a call at (386) 423-9161

Please allow 72 business hours or 3 business days for us to respond. Please note if this request is due to a missed appointment by either a late cancellation or no show you will be asked to make a follow up appointment before the request is filled. If you choose to call the office please only leave a message on the refill line. Calling and leaving multiple messages will only create more work and delay the process. Thank you for understanding.

Innovative Care by Expert Clinicians