REGISTRATION FORMS TO BE COMPLETED:

PLEASE COMPLETE AND SIGN FORM NUMBERS 1,2 AND 3 AND BRING THEM WITH YOU TO YOUR APPOINTMENT.   THE OTHER FORMS ARE FOR YOUR INFORMATION AND TO DOWNLOAD AS YOU WISH.

THANK YOU !

1)  CLIENT REGISTRATION FORM

OR

1)  CHILD REGISTRATION FORM

HIPAA NC NOTICE OF PRIVACY FORM

2)  HIPAA NOTICE OF PRIVACY SIGNATURE SHEET

FINANCIAL POLICY CLIENT COPY

3)  FINANCIAL POLICY SIGNATURE SHEET

 


//www.googletagmanager.com/ns.html?id=GTM-WQQ9HL
(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({‘gtm.start’:
new Date().getTime(),event:’gtm.js’});var f=d.getElementsByTagName(s)[0],
j=d.createElement(s),dl=l!=’dataLayer’?’&l=’+l:”;j.async=true;j.src=
‘//www.googletagmanager.com/gtm.js?id=’+i+dl;f.parentNode.insertBefore(j,f);
})(window,document,’script’,’dataLayer’,’GTM-WQQ9HL’);

Advertisements