Forms

Please fill it out prior to your appointment. Can be emailed back to referrals@focusandbalance.org or can be brought to your visit.

Patients over the age of 18 must fill out any information to release any information to parents, family members, spouses, doctors, schools, etc.
Release of information

If under the age of 18 and whose parents are separated/divorced we require both parents to fill out. Must be turned in 48 hours prior to the child's visit.
consent to treat minors.