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Forms

General Description
New Patient Pack This is a complete pack of forms for new patients
Telehealth Consent This form is for telehealth services.
Email Consent This form for consent for email communication.
Patient Registration Form This form contains patient address, insurance, contact information, and other registration information
Medical Records Authorization This authorization form directs your other providers to release your medical records to the Charis Clinic
Health Information By Alternate Means This form authorizes Charis Clinic to leave health information for you by email, voice message or text
Financial Policies This form contains our financial, payment and credit card policies.
Notice of Privacy Practices This form contains our privacy practices
Acknowledgement Privacy Practices This form acknowledges receipt of our privacy practices
History and Screening Forms Description
Child History Our history form for children
Adult History Our history form for adults
Child Anxiety Screening Form This contains the SCARED anxiety screening form
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