Patient Forms
Patient Forms and Important Documents
To help make your visits as smooth and efficient as possible, please review and complete any required forms before your appointment. Below you will find all patient forms and important documents for new patients, existing patients, and medical marijuana evaluations. If you are unsure which forms apply to you, please contact our office and our staff will be happy to assist you.
New Patients
Forms for Your First Appointment
If you are a new patient, please print and complete the following forms and bring them with you to your first appointment.
Initial Appointment Cancellation Policy Form
Please review and sign this form before your first appointment.
Download Cancellation Policy Form →Record Release Form
If you would like to send records to our office or request that our office send records to another provider, please complete this form. This can be especially helpful if you have prior psychiatric or therapy records.
Download Record Release Form →Existing Patients
Authorizations and Information Sharing
Current patients may use the forms below to authorize communication or information sharing.
Authorization for Release of Information
If you would like a family member, friend, or caregiver to have access to your Protected Health Information, please complete this form and bring it to your next appointment.
Download Authorization Form →Coordination of Care Authorization
If you would like your clinician to communicate with another doctor, therapist, or healthcare provider regarding your treatment, please complete this form and bring it to your next appointment.
Download Coordination of Care Form →Rescind a Release of Information
If you would like to revoke an existing Release of Information form without submitting an updated authorization, please contact our office directly to discuss next steps.
Contact Our Office →Medical Marijuana Patients
Required Documents for Medical Marijuana Appointments
If you have scheduled a Medical Marijuana appointment, please complete the following steps before your visit.
Pennsylvania Medical Marijuana Registration Instructions
Before your appointment, you must apply for your Pennsylvania Medical Marijuana ID card or access account. Instructions for registration can be found here.
View Registration Instructions →Medical Marijuana Informed Consent Form
You must bring a completed Medical Marijuana Informed Consent Form to your appointment.
Download Informed Consent Form →Get Started
Need Help?
If you have questions about which forms you need, how to complete them, or where to send records, our staff is happy to help.