consent to treat

PLEASE READ, SIGN & SEND OR BRING TO ACA

You may print, fill out, scan and fax if you prefer.

consent to treat

telehealth informed consent

PLEASE READ, SIGN & SEND OR BRING TO ACA

You may print, fill out, scan and fax if you prefer.

telehealth informed consent

financial agreement

PLEASE READ, SIGN & SEND OR BRING TO ACA

You may print, fill out, scan and fax if you prefer.

financial

hipaa consent

PLEASE READ, SIGN & SEND RELEASE OR BRING TO ACA

You may print, fill out, scan and fax if you prefer.

hipaa NOTICE   READ THIShipaa RELEASE  SIGN THIS

release of information

IF YOU WANT A RELEASE IN PLACE-

FILL IN, SIGN & SEND

OR BRING TO ACA

release of information