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Blue Mountains
Blue Mountains

Helpful Forms and Information

Your First Appointment

Your first appointment will be an intake session lasting 60 minutes unless otherwise specified. In some cases, the intake may be 90 minutes for famiies with teenagers. Please download the forms below and bring them to your first session. If you are an adult over the age of 18, please complete the Adult Intake forms and bring them with you.

If the appointment is for your child, please complete the Child Intake forms and bring them with you. Please do not bring your child to the intake session. It is important for parents to be able to talk privately about their concerns without the child present. If you are divorcing or are divorced, you must bring the section of the divorce decree outling who can authorized health care. 

Child and Adolescent Intake Forms


Adult Intake Forms

1. Adult Intake Questionnaire
2. Consent for Treatment Form 
3. Authorization to Disclose Information Form to coordinate care with your physician.
4. Notice of Privacy Practices Please review this information and keep a copy for your records. 

 

Note: To download Adobe Acrobat Reader for free, click here.

 

 

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.

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Helpful Forms

Click here to view and print forms for your appointment.

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