Recovery Medical

Forms

patient forms

New patients should 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 new patient forms.  You may complete this on your computer via Adobe Acrobat/Adobe Fill & Sign (free app on your phone) or you may print and complete manually.  Please bring this paperwork with you to your first appointment. If you are unable to complete in advance, you may complete in the office.

We ask that you arrive at least 15 minutes prior to your new appointment to complete the required forms/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.  Please complete this form if you have Medicare or Medicare Advantage plans and be aware you must pay in full at time of appointment.

HIPAA Privacy Notice

Read our HIPAA Privacy Notice above.

hipaa CONSENT FORM

All patients new and existing must sign this upon visit, including telemedicine.

suboxone progress report

To ensure we have up to date information for 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 it.  Otherwise, please complete the form over the phone with the physician per usual.