If you are wanting to set up a new patient appointment please give the office a call first at (386) 423-9161 and speak with one of our intake specialist. We try our best to find the Counselor or Provider that is the right fit for you. Once you have an appointment we will ask you to return here to complete the needed forms based on your appointment type. Thank you for understanding.
All new patients must complete this paperwork and submit it to the office before your appointment.
You can complete by digital signature and digital submission by clicking here New Patient Paperwork or by PDF by clicking the paper/pencil icon.
QUESTIONNAIRE for MEDICATION MANAGEMENT -
Please complete and bring with you to your first session if you are being evaluated by a prescriber for medications.
CONTROLLED SUBSTANCE AGREEMENT -
Please complete and bring with you to your first session if you are being evaluated by a prescriber for medications.
You can complete by digital signature and digital submission by clicking here Controlled Substance Agreement or by PDF by clicking on the paper icon.
ADULT HISTORY INTAKE FORM -
Please complete and bring with you to your first session.
COUPLES HISTORY INTAKE FORM -
Please complete and bring with you to your first session.
CHILD HISTORY INTAKE FORM -
Please complete and bring with you to your first session.
Medication Refill Request - Please either complete the form here or give us a call at (386) 423-9161
Please allow 72 business hours or 3 business days for us to respond. Please note if this request is due to a missed appointment by either a late cancellation or no show you will be asked to make a follow up appointment before the request is filled. If you choose to call the office please only leave a message on the refill line. Calling and leaving multiple messages will only create more work and delay the process. Thank you for understanding.