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Forms

General Description
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
Mental Health Services 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
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