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Intake Forms:

Patient Information Form
Primary Insurance Information Form
Notice of Policies and Practices to Protect the Privacy of your Health Information
Clinician Client Service Agreement
Financial Agreement
Record of Medication

Please Note: While email is not secure for purposes of privacy, you can elect to use email to communicate with our office. In so doing you understand, we cannot guarantee privacy to the standards established by HIPAA.

Please do not use our email system to cancel appointments or to forward sensitive information such as insurance or social security numbers. If you would like a response to a question, please specify if you would like the answer/information via phone call or email.

© 2017 Vista PCC