Patient Forms

New Patient Paperwork

Please have these patient forms filled out prior to your appointment at our clinic in Greenville, SC.

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Welcome LetterDownload PDF General Consent for Care & TreatmentDownload PDF Notice of Privacy PracticesDownload PDF Acknowledgement of Privacy NoticeDownload PDF Consent to Release Medical InformationDownload PDF Appointment Reminder ConsentDownload PDF Email ConsentDownload PDF Telehealth Informed ConsentDownload PDF Controlled Substance AgreementDownload PDF Medicare Private ContractDownload PDF Self-Referral FormDownload PDF Provider Referral FormDownload PDF

Ready to Send?

After filling out the referral and other forms, click the button below to send them to us.

Form Submission

Please attach your completed forms to the email. For your privacy, avoid typing sensitive medical details directly in the message body — email is not a fully secure channel.

Contact our clinic for personalized psychiatric, familial, and substance addiction care. We proudly serve patients in Greenville, South Carolina, and the surrounding areas.