Please complete the following online forms:
Telehealth: Please submit forms within 12 hours of your first appointment. Without these forms, your Telehealth appointment will need to be rescheduled.
In-office appointments: COVID-19 Hold Harmless Disclosure
Give us a call or email if you have questions about which forms are needed.
We value your feedback and invite you to complete a brief feedback form about your experience.
When you want your clinician at APS to share your protected health information (PHI), you need to complete a Release of Information form (sometimes called an "ROI"). The ROI you provide tells your clinician how/to whom they may share your information (your PHI).
Protected Health Information (PHI) includes:
The Release of Information agreement is needed for the APS clinician to share your protected health information (PHI) with others.
You may want your clinician to communicate with one or more of the following:
Click below if you are ready to complete the Release of Information form for your APS clinician.