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Blue Mountains
Blue Mountains

Patient Forms


First Appointment Forms

Please complete the
First Appointment Forms prior to your first appointment. 

- You may complete the forms online and then print them to bring with you

OR

- you may print them out and complete them by hand. 

It is very important that you bring the 
completed forms with you to your first appointment in order for us to be able to spend our time together focusing on your reason for seeking treatment. 

Please do not email your forms as email is not a secure method of sending sensitive and personal information. 

If you would like to fax your first appointment forms to me prior to your appointment and you have access to a fax machine you may fax your forms to my office at:  877-253-6065. 

If you have any problems accessing or printing these forms please let me know before your first appointment.


Insurance Benefits Verification (optional)

If you plan to use insurance to cover the cost of your appointment(s) the form below is provided as a courtesy for you to verify your insurance benefits:

Insurance Benefits Verification Form








 Note: To download Adobe Acrobat Reader for free, click here.


Helpful Forms

Click here to view and print forms for your appointment.

CLICK HERE