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• Intake Initial Packet– ENGLISH

• Credit Card- ATM- Self Payment– ENGLISH

• Release of Information (ROI)– ENGLISH

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• Intake Initial Packet– SPANISH

• Credit Card- ATM- Self Payment– SPANISH

• Release of Information (ROI)– SPANISH

 

INTAKE SINGLE PAGES– ENGLISH

• DEMOGRAPHICS

• INFORMED CONSENT

• HIPAA CONSENT

• INSURANCE–VERIFICATION FORM

 

INTAKE SINGLE PAGES– SPANISH

• DEMOGRAPHICS

• INFORMED CONSENT

• HIPAA CONSENT

• INSURANCE–VERIFICATION FORM

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• Good Faith Estimate Faith EstimateGood Faith Estimate

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• ADDITIONAL INFORMATION PAGE