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Printable Forms

Bring your completed forms to your appointment. Save time during your visit and speed up your check in process! Be sure to ask which forms you will need to bring when you make your appointment with us at 866-904-7721.

If you are a self-paying client or applying for funding, please make sure to bring proof of income and photo id with you to your visit.  If you are paying with insurance, please make sure to bring your insurance card, co-pay, and a photo ID with you to your visit.

To download a form, click the appropriate language underneath the service you are requesting. Please be sure to print clearly and in blue or black ink.

 

New Clients
(Clients who have not been seen in over a year)
English Español
Existing Clients
(Clients who have been seen within a year)
English Español
Take Charge Application
English Español Russian
Additional Forms
Release of Information (Eng/Spa) Fact Sheets


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