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Client Forms

After you have been accepted as a new patient and have an appointment scheduled with a provider, please read and complete the necessary forms before your first appointment.
Click on the links to the right to complete the relevant forms.

After you have been accepted as a new patient and have an appointment scheduled with a provider, please read and complete the necessary forms before your first appointment.
Click on the links below to complete the relevant forms.

All Patients
Please use the UPLOAD link below to send us a copy of your insurance card (front and back) and a photo ID. You will be asked to update the Patient Registration Packet on an annual basis.

New Adult Patients
Please review and complete forms 1-7. Answer the questions and push submit when complete. Your documents will be sent to us directly and securely.*

If you are scheduled to see one of our therapists, please also fill out form 13 and 14.

New True North TMS Patients:

Click here for True North TMS Client Forms

New Adolescent Patients
Please complete forms 1-8. The Child Behavior Checklist (form 8) will need to be printed and filled out by a parent or guardian. Once completed, you may fax it to 907.222.0754 or if you scan the document, you may use the UPLOAD link below to send it securely.

All In-Person Appointments

Please fill out and submit the COVID-19 Patient Questionnaire and Waiver Form (form 15) within 24 hours of each in-person session. If your answers change or you become symptomatic on the day of your appointment, please give us a call and your appointment can be easily switched to a telemedicine appointment or rescheduled. Please visit our COVID-19 page to see our current policies and who is eligible for this option.

Mood Tracking Form
The Mood tracking chart is available to download and print should you and your provider find this a helpful tool.

If you have any questions or need assistance, please feel free to call us at 907.222.0753. Our staff is happy to help.

* Form 9 is a HIPAA Privacy Notice for your review only and is available to print.

Upload
Use the UPLOAD link above to securely send Willow Medical your confidential documents and photos.