New Patient Forms

These patient information forms will help streamline the assessment process. If you have any questions about these forms, Dr. Felder will be glad to entertain them during your visit. Print and fill out each form and bring them with you to your initial appointment. If you are insured, please bring your insurance card with you to your first visit.

• Personal Information

• Authorization for Treatment

• Fee Information

• Symptom Survey

• Office Policy on Insured and Managed Care Patients
• Insurance Benefit Worksheet

• Information on Manged Care

• Notice of Privacy Practices for Protected Health Information

• Patient Acknowledgement Form

• Patient's Rights

• Authorization to Disclose Information

• Couples and Families Agreement

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