Forms- PLEASE NOTE FORMS ARE BEING UPDATED & CONSOLIDATED. IF YOU NEED A COPY OF A FORM, PLEASE CONTACT OFFICE @ 910-585-6108. THANK YOU FOR YOUR PATIENCE.
Provided below are links to forms in which you may download and complete prior to your initial visit. Click on the form to open it.
**NOTE: Once you call to schedule your initial appointment, you will get an invitation to join the patient portal. Through the patient portal, you may securely fill out, send the forms, and schedule appointments. If you have any questions, concerns or need assistance, please do not hesitate to contact me.
**NOTE: Once you call to schedule your initial appointment, you will get an invitation to join the patient portal. Through the patient portal, you may securely fill out, send the forms, and schedule appointments. If you have any questions, concerns or need assistance, please do not hesitate to contact me.
Included in the Welcome Packet are the following and required PRIOR TO ALL first appointments:
- Welcome Form
- North Carolina Notice of Policies to Protect the Privacy of Your Health Information (NPP and HIPAA)
- Patient Agreement for Services
- Informed Consent to Telehealth - Addendum to Patient Agreement for Services
- Release of Information (ROI)
- General Intake Information Form
- Patient Health Questionnaire (PHQ-9 Assessment)
- Generalized Anxiety Disorder Scale (GAD-7 Assessment)
- Treatment Plan Agreement
- Crisis & Emergency Services Contact Information
- Good Faith Estimate (GFE) / No Surprises Act (NSA)
- Payment Authorization Form (this form is not kept on file in the office)