PLEASE COMPLETE & E-SIGN THE FORMS REQUESTED BY OUR STAFF:

New Patient Paperwork

All New Patients - Complete this form prior to first visit

MENTAL HEALTH INTAKE FORM

All new Mental Health Patients - Complete this from prior to first visit

ADHD Assessment

Complete this form to take ADHD Assessment

Authorization for 3rd party Access to Healthcare Records

Hepatitis C Consent

Complete this Form for Hepatitis C Consent

Chronic Pain Management Consent

Complete this form for Chronic Pain Management Consent

MAT/Buprenorphine/ Suboxone Consent

Complete this Form to Consent for MAT/Buprenorphine/ Suboxone Consent

Depression Screening Brief Survey

Complete this Depression Screening Evaluation Form for your provider to interpret and discuss with you on your visit

Medical Records Release - Carelock to 3rd Party

Complete this Form to Consent for Medical Records Release - Carelock to 3rd Party

DAST Screening Test

Complete this Form for your DAST Screening if your Provider requests it

Medical Records Release - 3rd Party to Carelock

Complete this Form to Consent for Medical Records Release - 3rd Party to Carelock

ADHD Treatment with Stimulants Consent

Complete this Form to Consent for ADHD Treatment with Stimulants Consent

Benzodiazapine Treatment Consent

Complete this Form to Consent for Benzodiazapine Treatment Consent

Annual Wellness Visit Questionnaire

Complete this Form for Annual Wellness Visit

ADDITIONAL FORMS:

Testosterone Replacement Therapy Consent Form

Complete this Form to Consent for Testosterone Injections or Topical Medication

More Forms Soon