Printable Forms

To use these forms:

1.) Download the PDF files below
2.) Print and fill out
3.) If these forms are not completed and signed in our offices they must be notarized prior to submission

• Authorization to Provide Services to Minors (Persons Under Age 18) – Married Parents / Joint Custody
• Authorization to Provide Services to Minors (Persons Under Age 18) – Single Parent / Sole Custody
• Communication of Protected Health Information
• Medical Records Release
• Primary Care Provider Coordination of Care
• Statement of Limited Liability