Printable Intake Forms

Client Intake Forms

Please find links below to our Client Intake Forms in PDF format. Clients are advised to download and bring completed forms to their intake appointment along with appropriate insurance information. If you have any questions or need assistance, please call (505) 830 1871.

General Intake
Medical History
Clinical Policies
Notice Of Privacy Practices
Notice Of Confidentiality Of Alcohol And Drug Abuse
Receipt Of Notice Of Privacy Practices
Disclosure Of Health Information
Permission For School-Based Services
Request For Services By A Minor
Financial Responsibility
Telehealth Consent