New Patient Forms
Before your first appointment, please complete all the following forms. The Patient Information Form and Office Policies Form are available for online submission. Allow at least 15 minutes to complete the Patient Information Form. If you prefer to print a PDF and mail it to our office, please mail your forms at least 5 business days before your appointment to allow time for processing. The Document Upload allows you to upload a photo of the front and back of your insurance card and driver's license. We recommend that you do this on your smartphone.
Please call the office prior to completing the following forms.
Patient Information Form
Provide your contact and insurance information, as well as details on your medical history, current concerns and current medications.
Office Policies Form
Learn about our office policies and acknowledge receipt of our Privacy Practices.
Upload images/PDFs of your insurance card (front and back) along with the front of your driver's license. This can be done easily through your smartphone.
**Note that documents uploaded are not checked on a timeline and are never checked outside of business hours. In case of an urgent situation please call 9-1-1.
Consent for Release of Information Form*
*Needed for parents of patients under the age of 18.
These links should direct you to forms you may need if you are applying for esketamine (Spravato) treatment through our office. Please complete these forms if directed by our office staff, and then submit them to us. Forms may be submitted through the document upload feature below or on our forms page.
Complete form online then add total combined score.
Spravato REMS Form
Complete page 2 only and then submit to our office.
Spravato Benefits Investigation Form
Complete pages 3-6 only and then submit to our office.
Upload files here