Intake Forms

1. Click on the desired form below.
2. When the form loads, click the download arrow (Click here for a screenshot).
3. Open the form in your downloads folder and complete to the best of your ability. If you are not sure of certain information, skip and you can complete during your office visit. Some fields are not “fillable” intentionally (social security, payment info, and signatures) intentionally, so that you can complete when you come for your appointment.
4. Once you complete the form, click “File”, “Save” in the PDF viewer (Click here for screenshot).
5. Complete the Completed Intake Form below and upload your completed form there. You may complete and upload multiple forms at one time.

New Patient Forms

• BACC New Patient Forms
• Adult Problem Checklist
• Telehealth Agreement

Adolescent / Minor Forms

• Adolescent Intake Form
• Child Intake Form

Completed Intake Forms

Please submit your completed intake forms here: