Breakthrough Healthcare Solutions

Client Forms

Save time at your appointment by completing your new patient paperwork in advance.

Please download, complete, and bring the appropriate forms to your first appointment. If you have any questions about which forms apply to you, please call our office.

New Patient Forms

New Client Health History

Comprehensive health history questionnaire for all new clients.

HIPAA Privacy Notice & Acknowledgment

Required acknowledgment of our privacy practices.

Financial Policy

Outlines our financial policies.

Autism Program Forms

Autism Intake Questionnaire

Detailed developmental and symptom history for autism program clients.

Parent Consent for Treatment

Required consent form for minors receiving treatment.

Forms are currently available in-office. Please contact us to request forms be sent to you in advance.