Welcome!

In order to avoid problems with insurance verification, please complete the following form at least 3 days before your first appointment 1 of the 3 following ways:

1. Online
2. Fax
3. Email

Payment will be due at the time of service if we do not receive New Client Information form at least 72 hours before your first appointment. Thank you for your cooperation and we look forward to meeting you.

Option Submit Online

1. Information is being submitted to an email that is a secure, HIPAA compliant email.  Data is encrypted in order to ensure confidentiality
2. Click on the Online New Client Information Form link and fill in requested information
3. Make sure to hit submit

4. Online New Client Information Form

Option Email

1. Save first in your own My Documents
2. Make changes
3. Email Attachment, recoverynow@hipaamail.us
4. This email is a secure, HIPAA compliant email.  Data is encrypted in order to ensure confidentiality

Option Fax

1. Complete Online Form By Entering Client Information
2. Fax to (888) 345-6044

Form to be Completed Email or Fax

New Client Information