New Clients:

Please complete the following Consent Forms and the applicable Personal History Form and bring the completed forms to your first appointment:

Patient Consent Forms

Adult Personal History Form

Child/Adolescent Personal History Form

If you plan to use insurance, please complete the following form and return it to our office by e-mail or fax at least 24 hours prior to your appointment:

Insurance Screening Form

If you would like us to be able to communicate with or send records to another party, we need a request in writing as well as a written consent to release specific information.  Please complete the following form and return it to our office by e-mail or fax with your written request for information:

Authorization to Release Information Form

Agencies:

We gladly accept referrals from other agencies. Please fax the attached form back to us at (407) 977-4370 and we will contact the client to schedule an appointment.  

Referral Form

Please send a release of information with the referral in order for us to notify you of contact made. You may send your own release form, or use our release form.