New Patient Forms

New Patient Registration Packet

Required for all new patients.

• Patient demographics
• Emergency contact information
• Insurance information (if applicable)
• Pharmacy information
• Communication preferences

Addiction Medicine Intake Packet

Required for patients seeking addiction medicine services.

• Medical history
• Substance use history
• Prior treatment history
• Current medications
• Recovery goals
• Mental health screening

Notice of Privacy Practices (HIPAA)

Explains how your protected health information may be used and disclosed.

Financial Policy

Explains insurance billing, self-pay fees, payment expectations, chargeback policies, and financial responsibility.