3295 Forest Inn Rd, Suite 3

Palmerton, PA 18071

3735 Easton-Nazareth Hwy, Suite 102

Easton, PA 18045

Palmerton Office

Easton Office

Forms Cabinet

New Client Forms

Complete Form

Child Packet

This packet to be filled out by a parent /guardian for clients who are 5-13 years old

Complete Form
Adolescent Packet

This packet to be filled out by the client (adolescent) and parent /guardian for clients who are 14-17 years old

Complete Form
Adult Packet

This packet to be filled out by the client who is 18 years old or older

Complete Form
New Patient Forms
  • Adult (18+ yrs old)
  • Child (5-13 yrs old)
  • Teen (14-17 yrs old)
  • Couples
  • Family
Complete Form
Release Forms
  • Insurance Release Form
  • Parent Release Form
  • Medical Records Release
Complete Form
Miscellaneous Forms
  • Financial Policy
  • Credit Card on File
  • Payment Plan
  • Financial Hardship