New Patient Forms
Initial EvaluationSelect the appropriate intake form below.
For new patients under age 18 years, please complete the Child/Adolescent Intake Form. We are not accepting new adult patients at this time. Forms must be completed and returned to request an initial appointment. Please check the insurances accepted by the office prior to submitting forms. Please fax the completed forms to (517) 347-8420. Please note the office must accept the fax, which is typically available from 8:30 am to 4:00 pm daily (except for the noon hour), but you can call the office to confirm. |
Office FormsAll new patients must complete, sign and return the below forms prior to the initial appointment.
These forms can also be completed online in the patient portal and will be sent electronically prior to the appointment. Consent for Treatment Consent to Text/Email Office Policies & Procedures It is recommended the Release of Information is completed for a primary care physician and/or therapist to allow exchange of information, but this form is not required. This form is not available in the portal. Release of Information |