Recovery Medical

Forms

patient forms

New patients can complete their paperwork in advance of their appointment to help expedite their time in the office.

Please click the link to open the PDF for the applicable new patient forms.  You may complete this on your computer via Adobe Acrobat // Adobe Fill & Sign (including free version and on your phone) or you may print and complete manually.  Please bring this paperwork with you to your first appointment; if unable to do so, you may complete in the office and we ask that you arrive at least 15 minutes prior to complete the required forms and releases.

 

New maintenance Patient FOrms

For all new Addiction/Recovery Patients.

new General psych patient forms

For all new General Psych Patients.

Informed Telemed consent form

In addition to new patient forms, please complete this form if you are participating in telemedicine services before your first telemedicine appointment.

medicare opt out agreement

Our office does not participate in Medicare.  You need only complete this form if the front office staff has advised you to do so.

HIPAA Privacy Notice

Read our HIPAA Privacy Notice above.

hipaa CONSENT FORM

All patients new and existing (periodically) must sign this upon visit including telemedicine.

suboxone progress report

To ensure we have up to date information in your treatment, maintenance patients must complete this form before each appointment.  If you are able to save and send by email (tip: Adobe Fill & Sign app), send to susan@recoverymedical.org and notify the office of this when you make payment so they can confirm they have received by email.  Otherwise, please complete the form over the phone with the physician/staff per usual.