Customer Forms

Payment Agreement

 

Patient Consent to Treatment

 

Your Health Information Privacy Rights

 

Intake Form - this is a form you can fill out on your computer.

Make sure you "Save" after filling out your information. Then you can either print out the form or email it to the doctor prior to your first visit.

 

Hypnotherapy Intake Form

 

You will need Adobe Acrobat Reader to open these files.

Click one of these links to download the program.

 

Acrobat Reader for Windows

Acrobat Reader for the Mac