Forms

You may print out the forms below and bring them to the office OR Fill out the info below, print, sign, scan, and attach below. You can also send all forms to office@thcevaluation.com

Form #1 – Patient Information Form


Form #2 – Chief Complaint Form


Form #3 – Acknowledgement


Form #4 – Medical Release

Medical Release Form from your doctor. If you already have your medical records, then you do not need the Medical Release.


IF YOU CAN’T GET YOUR MEDICAL RECORDS IN A REASONABLE TIME JUST HAVE YOUR CARE PROVIDER FILL OUT THIS FORM AND SEND IT TO: office@thcevaluation.com or FAX 617-419-1051

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