3774 Ridge Pike, Collegeville PA 19426

601 Gay Street, Phoenixville PA 19460

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For your convenience and decrease your wait time, please complete the following packet and bring this information with you to your initial intake appointment. If you are unable to view/print these forms, we request that you arrive 15 minutes prior to your appointment time to complete paperwork.

Included in the packet:

Client Information

A basic information sheet for our records.

Consent for Release of Information - General

This for is to authorize the release of protected health information.

Release of Emergency Contact Information

This form is to authorize the release of all emergency contact information.

Release of Information for Primary Care Physician

This form must contain your Primary Care Physician's (PCP) contact information. This is your consent allowing us to speak to your PCP if additional correspondence is needed for your continued treatment.

Consumer Agreements and Authorizations

This form is information regarding consumer agreements and authorizations.

Informed Consent for Treatment

This is a consent form for treatment.

Client Communication Consent

This is a consent form for communicaton between practice and consumer.

Medication and Symptom Review

This is a worksheet to review medications and symptoms with your doctor.