Patient Forms

Here is a list of the most common forms needed for our patients and services.  Just click the link below and fill out the forms then return to us.  For more information or questions please give us a call at 505.327.0002

New Patient Packet

Our new patient packet can be printed off, filled out completely, and submitted to our physical location at 1009 Ridgeway Place Farmington, NM 87401 with a copy of your ID and Insurance Card(s). This packet includes a patient information form, current medication list, insurance information form, financial agreement form, acknowledgment of receipt of notice of privacy practices, no show/ late cancellation policy, and informed consent for treatment. We ask that all forms be filled out completely and accurately before submission.

Notice of Privacy Practices

This notice describes how behavioral health care (mental health) information about you may be used, disclosed, and safeguarded, and how you can get access to this information. If you are considering becoming a patient in our office, please review this document carefully. The confidentiality of your personal healthcare information is very important to us and will always be a priority in our practice

Release of Information Form

This form is generally used for our office to obtain medical records for new patients that are going to be joining our practice. If you are interested in becoming a patient, or obtaining your medical cannabis certification, there is no need to print this off and fill it out. Come on into the office and we will help you get started.

New Patient Packet

Click the link above to Download the packet.

Notice of Privacy Practices

Click the link above to Download our Privacy Policy.

Release of Information Form

Click the link above to Download the form.