New Client Forms

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.

National Forms

  • Notice of Privacy Practices and Client Rights For your information only
  • Patient Registration Please complete all applicable sections
  • Release of Information Carefully and fully complete this form if you want information about your care provided to another person.  Please note that there may be a charge for the copying and processing of medical records.  Your records are confidential and will not be provided to anyone without your written consent, except as allowed by federal and/or state law.

EN ESPANOL

ILLINOIS

Outpatient

Catalyst and Breakaway Forms

Neuropsychological Testing

MARYLAND

PENNSYLVANIA

TEXAS

Outpatient

Catalyst and Freedom Forms

Medication Management

WASHINGTON

The following form is only for clients 15 years old or younger.