Forms and Links
How to Fill Out and Submit Forms
*Please download Adobe Acrobat Reader prior to downloading the forms and then save them after they’re filled in. Thank you!
Consent Form for Telehealth
This 2-page PDF document is required for compliance with current laws that protect privacy and confidentiality which also apply to Telemental health services. Exceptions to confidentiality are described in the Notice of Privacy Practices that FPS uses. Telemental health services are provided through a HIPAA compliant and secure platform. No permanent video or voice recordings are kept from Telemental health sessions. Client may not record or store video from sessions.
Download
Consent Form for Telehealth
Privacy Practices & HIPAA Form
This 6-page PDF document (including one-page form) is a required "notice of privacy practices" (NPP) in keeping with Federal HIPAA (Health Insurance Portability and Accountability Act, 1996) requirements. Click to download.
Download
Privacy Practices & HIPAA Form
Initial Patient Information Form
Two-page form in PDF format: Name, address, phone, Emergency Contact Information, Receipt of Notice of Privacy Practices. Click to download.
Download
Initial Patient Information Form
Medical Billing Information Form
One-page PDF form: Primary Care Provider, emergency contact info, insurance information.Download
Medical Billing Information Form
Medication Information
Information on specific medications, side effects, and contraindications. Also a link to a patient assistance program offering aid for people that need financial help paying for their medications. |
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12 Step Programs
Links to the most popular 12 step organizations with meeting schedules. | |
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Recommended Chiropractors
Here is a list of local chiropractors that are recommended by this office. | 1 | ![]() |
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