Forms

Online Balance Payment

This form will be used to pay your existing balance.

Psychotherapy Telehealth Informed Consent

Administrative Forms

HIPPA Forms

Prior Authorization Form

Please open the link below and fill out the form. Your request is sent directly to your provider.

Medication Refill Request

When you request a medication refill, your medication will be sent within 24 hours. Your pharmacy should notify you when your medication is ready.

*If your insurance company requires a prior authorization before they will approve a prescription, they will often take 72 hours to process the P.A. Your pharmacy will receive a notification when the PA has been approved, If your medication was not approved, our office will receive a fax to that effect and you will be asked to make an appointment to discuss other medication options.