Forms

Below you will find the intake questionnaire you must complete and send to us with your medical records.

Make certain to send this completed questionnaire to us along with your medical records.

Below you will find the form physicians and hospitals will require in order to release your medical records to you.

Fax your records, along with the completed questionnaire above, to us. You may have your physician’s office fax the records directly. You will need to send the questionnaire to us separately.