New Client Forms
Client Care
The following forms are provided for Meier Clinics clients who would like to print and complete them prior to their appointment. Please note: you may still need to sign or complete additional forms at the time of your appointment.
Please print all national forms and then check if any are listed under the state and program for which you are receiving care.
If you have any questions about the forms or need assistance in completing these forms, contact the office where you made your appointment. We will also be happy to answer any questions when you come in for your appointment or give us a call at 888-725-4642
All forms are provided in Adobe Acrobat. If needed, you may download this program for free at: get.adobe.com.
En Espanol
- Autorizacion Para Uso y Revelacion de Informacion de Salud Protegida (Illinois)
- Autorizacion Para Uso y Revelacion de Informacion de Salud Protegida (Texas)
- Aviso de Practicas de Privacidad y Derechos del Cliente
- Consentimiento Informado de Telemedicina
- Consentimiento Para Servicios Telemedicina
- Declaración de Divulgación Financiera
- Evaluación Psiclo-Social (Illinois)
- Evaluación Psiclo-Social (Illinois) - Online
- Questionario/Psico -Social Para Padres /Guardian Legal
- Registración Para Pacientes
Idaho
- Consent to Telemedicine Services
- Financial Consent to Telemedicine Services
- Notice of Privacy Practices and Client Rights
- Outpatient Procedure Charge List
- Parent/Legal Guardian Questionnaire/Psychosocial
- Parent/Legal Guardian Questionnaire/Psychosocial - Online
- Patient Registration
- Psychosocial Assessment – Age 16 and Above
Illinois
- Consent to Telemedicine Services
- Consent to Treatment
- Financial Consent to Telemedicine Services
- Notice of Privacy Practices and Client Rights
- Outpatient Procedure Charge List
- Parent/Legal Guardian Questionnaire/Psychosocial
- Parent/Legal Guardian Questionnaire/Psychosocial - Online
- Patient Registration
- Psychosocial Assessment – Age 16 and Above
Kansas
Maryland
National Forms
Texas
Washington
- Consent to Telemedicine Services
- Financial Consent to Telemedicine Services
- Notice of Privacy Practices and Client Rights
- Outpatient Procedure Charge List
- Parent/Legal Guardian Questionnaire/Psychosocial
- Parent/Legal Guardian Questionnaire/Psychosocial - Online
- Patient Registration
- Psychosocial Assessment – Age 16 and Above