Forms

Please fill out the New Patient Forms and return them to us before your first visit.

Please download the appropriate forms.  You can fax those back to us at 561-852-0960.  You can also email those to info@exceptionalservices.net.

New Client Intake Form 

HIPAA requires that all healthcare professionals use encryption to transmit data over the internet to each other. Please be aware that our email servers use this high level of encryption.  Patients are allowed to use any email service they want, even if it’s their personal (unsecured) email address. However, if you are concerned about the security of your email transmission from your email provider’s unsecured server, then we recommend using some encryption before emailing your forms to us.