Clicking on a link will open your forms in a new browser window. To save, right click and choose “save target as” or “save as”.
New Patient Packet
- Intake Form
- Patient Membership Agreement
- Medical History Form
- Membership Fee Agreement
- Medicare Agreement – for Medicare eligible patients
- Narcotics Agreement – for patients taking controlled substances
- Recovery Services Treatment Contract – for recovery patients
- Records Request – from another provider to Vantage
- Records Release – from Vantage to another party
- Disclosure Authorization – allows communication with a family member, counselor, etc.
These files are in Adobe’s PDF format and require the Adobe Acrobat Reader. If you do not have the Adobe Reader installed on your machine, click here or on the Adobe Reader logo to get it!