To download forms, click the links below. Please print and fill out these forms. Once complete, please email them to us at firstname.lastname@example.org or mail them to our Clearwater Office before your first appointment.
- New Patient Form
- Patient Information Form
- Acknowledgment of No-Show Fee
- Acknowledgement of Class II or Class III Prescription Laws
- Medical Records Release Form
- Opioid Consideration Questionnaire
- Opioid Therapy Consent Form
- Long Term Controlled Substance Consent Form
- FDA Warning Acknowledgment Form
- Notice of Privacy Practices
- Acknowledgement of Receipt of Notice of Privacy Practices
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