Patient Forms

 If you would like to become a new patient in our medication-assisted treatment program, or if you have been a patient before and wish to re-apply, you must complete the form below. Once completed, the form is automatically submitted for review.  All applications are processed on a first-come-first-serve basis and acceptance is based on provider digression.  Once scheduled, you MUST bring your state-issued photo ID, counseling verification, and insurance information with you to your first appointment (note: photocopies are not accepted). The  form below also gives you the ability to upload your documents during the application process. 

 If you have an upcoming appointment scheduled at our office or if you'd like to become a new patient, please click the link below to access our new patient packet. We understand that an abundance of paperwork may seem overwhelming. Submitting it online is secure and will save you valuable time during your visit.   If you are unable to submit your new patient information online please arrive at least 30 minutes prior to your appointment time. 

 If you have an upcoming appointment scheduled at our office for medication-assisted treatment, please click the link below to access our new patient packet. We understand that an abundance of paperwork may seem overwhelming. Submitting it online is secure and will save you valuable time during your visit.   Please remember to bring your state-issued photo ID, and insurance card. If you are unable to fill out your new patient information online please arrive no less than 1 hour prior to your scheduled appointment time to allow for the completion of paperwork. 

Certain aspects of your care may require gathering or sending additional healthcare information. When directed by a member of our staff, please complete the consent forms below so we may request or share your health information with appropriate individuals or entities.  Please note that consents may be withdrawn at any time by verbal request and we will never share your information without your consent. 

Treatment plans are required at regular intervals to help track disease management.  If your provider has requested you to update your treatment plan please click the link below. 

Our new payment policy will be effective 03/01/2022. Please review and sign if you are an existing patient.