For your safety and convenience

We are providing the following HIPAA Compliant online forms. Please access and complete the necessary intake forms by clicking on the link for each section.  

Information Packet

Click to download PDF

Demographics

https://form.jotform.com/201116206244036

Substance Use History

https://form.jotform.com/201116055042034

Infectious Disease Risk Assessment

https://form.jotform.com/201114965242044

HIPAA Consent Form

https://form.jotform.com/201113504226034

Consent for Treatment

https://form.jotform.com/201217538144146