Please complete these forms before your first appointment
Required for all new patients. Collects your basic information, contact details, and reason for visit.
⬇ Download PDFOutlines the safe-use terms and responsibilities for medications classified as controlled substances.
⬇ Download PDFExplains how your protected health information is used and your rights under HIPAA.
⬇ Download PDFOutlines our billing practices, copay expectations, and payment responsibilities.
⬇ Download PDFRequired for all new patients. Covers in-person and telehealth services consent, insurance billing acknowledgment, and self-pay option.
⬇ Download PDFAuthorization for release/obtainment of information. HIPAA-compliant with Florida statute references. Valid for one year from date of signature.
⬇ Download PDFPrivacy Notice: These forms contain protected health information (PHI). For your security, please do not email completed forms with sensitive medical information. Instead, bring them to your appointment in person, or call us to arrange secure delivery. If you must email, please send to compassionatebhc@outlook.com and we will take appropriate precautions.
