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Print and complete these forms before your evaluation in order to comply with office efficiency as well as time saved at your appointment.

All dates on the following forms must match the day of your appointment. All forms must be brought in for your evaluation or you will be required to fill them out in office.

To obtain your medical records you must come in and show valid identification or you can fill out a HIPAA form to release the records. Please note, you must list who and where the forms are to be released to. Signing the form does not give Relaxed Clarity enough information on where to release the documentation to. This form can be emailed to

To obtain your medical records from your primary care or previous physician, please fill out the PHI form. This form can be brought in with you for your appointment and our staff will fax it for you so your medical records can be shared with us. You can also take this form to your primary care physician and hand the form to the nurse or assistant in the office and they will send us your medical records.

Downloadable Forms

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