| New Patient Pack |
This is a complete pack of forms for new patients |
| New Patient Information |
This form contains Charis Clinic basics |
| Patient Registration Form |
This form contains patient address, insurance, contact information, and other registration information |
| Medical Records Authorization |
This authorization form directs your other medical providers to release your medical records to the Charis Clinic |
| Health Information By Alternate Means |
This form authorizes Charis Clinic to leave health information for you bCarey email, voice message or text |
| Financial Policies |
This form contains our financial, payment and credit card policies. |
| Acknowledgement Privacy Practices |
This form acknowledges receipt of our privacy practices |
| Primary Care |
Description |
| Pediatric Medical History |
Our medical history form for patients under 14 years of age |
| Adult/Adolescent Medical History |
Our medical history form for patients 14 years old and older |
| PHQ-9 & GAD-7 Forms |
This contains the PHQ-9 & GAD-7 screening forms |
| Aesthetic Care |
Description |
| Botox Cosmetic Consent |
This form grants consent for Botox procedures |
| Botox Cosmetic Instructions |
Instructions for Botox patients |
| Cosmetic Client Questionnaire |
Questionnaire for suitability for cosmetic procedures |
| Cosmetic Juvederm & Botox Consent |
This form grants consent for Botox and Juvederm |
| Filler Consent |
This form grants consent for filler injections |
| IPL Pre and Post Treatment Instructions |
Patient instructions for before and after IPL treatment |
| IPL Hair Removal Treatment Instructions |
Patient instructions for before and after IPL hair removal |
| Laser Light Energy Consent |
General consent for IPL procedures |
