|Both the HIPAA Form and the Service Agreement should be read prior to signing the Consent Form, below.||HIPAA Form
|The PDF version of this form can be printed, signed, and brought to your first appointment.OR
The electronic version may be filled out and submitted online.
|Consent Form (PDF)|
|This form can be used to authorize charging your fees to a credit card or bank account.||Authorization Form (PDF)|
|This form can be used to authorize the exchange of emails and/or text messages with your provider.||Email/Text
Agreement Form (Optional)
|This form authorizes GLPG to release specific information to individuals or organizations.||Release of Information Form (Optional)|