Client Forms

To start our work together there’s a few forms to fill out first. Please print out and complete the forms below, signing them where necessary. Completing this paperwork before your first appointment will enable us to quickly turn our attention to solving your problem.

Client Information and Consent to Treat Forms
This form collects demographic information, provides consent for your treatment, and informs you of my practice policies.

Notice of Information Practice and Consent to Use Forms
This notice describes how information about you may be used and disclosed, and how you can gain access to this information. Please review it carefully.

Practice Policies and Pricing Form
This notice outline’s Dr. Pirtle’s policies on scheduling appointments, pricing, cancellations and refunds. Please review it carefully.

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