Intake Forms
Please download and print out the intake form that corresponds to your provider. Please bring completed contact information and signed consent forms to your first appointment. The remaining pages are for you to keep for your records. Feel free to contact us if you have any questions about filling out the forms.
Dr. Eric Morse: click here to download (.pdf)
Dr. Michelle Joshua: click here to download Information and Consent to READ (.pdf)
Dr. Michelle Joshua: click here to download Notice of Privacy Practices to READ (.pdf)
Dr. Michelle Joshua: click here to download Intake Form to COMPLETE (.pdf)
Dr. Heidi Green: click here to download (.pdf)
Dr. Jeff Krepps: click here to download (.pdf)
Keisha Hinton, LCSW, LCAS: click here to download (.pdf)
Dr. Katherine Walker: click here to download Counseling and Coaching Intake form (.pdf); click here to download Agreement (.pdf)
Dr. Katherine Walker: click here to download Couples Counseling Intake form (.pdf); click here to Pain Management and Biofeedback Intake form (.pdf)
Dr. Stephanie Marko: click here to download Intake form (.doc)
Joseph Rabiega, MA, LPC: click here to download Intake form (.pdf) (Please complete the first 4 pages and bring them to your first appointment along with your insurance card. Please read the last 7 pages carefully- you do not need to download them or bring to your appointment unless you have questions.)
Dr. Joshua Dittmer: click here to download Intake form (.pdf)
Dr. Jun He: click here to download (.doc)
Dr. Hima Palakurthi: click here to download (.pdf)
Dr. Jennifer Segura: click here to dowload Practice Policies 2013- please read; click here to download Child New Patient Form 2013; click here to download Adult New Patient Form 2013; click here to download Physical Examination Form from Your Physician 2013.