Forms

New Patients

• If you are a new patient, please print and complete these forms and bring them to your first visit.
• Please read and sign our Initial Appointment Cancellation Policy Form.
• If you would like to send records to our office or have our staff send records out, please sign the Record Release Form.

Existing Patients

• If you would like a family member or friend to have access to your Protected Health Information, please print and complete this form. Please bring the completed form to your next appointment.
• If you would like our Clinicians to communicate with another doctor or therapist about your ongoing treatment, please print and complete this form. Please bring the completed form to your next appointment.
• If you would like to rescind an existing Release of Information Form without providing updated information, please call our office to discuss next steps.

Medical Marijuana Patients

• If you have scheduled a Medical Marijuana appointment, please be sure to follow the instructions and apply for your Pennsylvania ID Card/ Access Account prior to your appointment. Instructions can be found on this form.

On the day of your appointment, you must bring a completed Medical Marijuana Informed Consent Form.