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Important Office Forms

Required forms for all new patients...

**Virtual Visit Consent Form**

**Email & Text Consent**

**HOPE419 Office Policies**

Additional forms...

Permission To Obtain Treatment

Informed Consent & Privacy Acknowledgement

Patient Bill of Rights & Grievence Policy

No Surprise Billing FAQs

Out of Network Form

Credit Card Authorization

Release Of Information

Medical Treatment of a Minor

Document & Form Request Policy

FMLA/Leave Request

Incident billing forms...

Incident Billing, Danielle Carruthers, LSW

Incident Billing, Bethany Tackett, LSW

Incident Billing, Anna Allen, LSW

Incident Billing, Hailey Schnellinger, LSW

Incident Billing, Seth Burriss, PMHNP

Incident Billing, Gabrielle Sword, PMHNP

Incident Billing, Cori Overs, LPCC

Incident Billing, Jules Cottrill, LSW

Incident Billing, Dominic Polifrone, PA-C

Tell us how we are doing. We want to hear from you!

Attuned Eating Group Survey

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