INTAKE PACKET
 
Below is the link to our intake packet. Please complete and return to Tami Corn at tamicorn@yahoo.com or by Fax: 972-421-1816. Please include front and back copies of your Drivers License and Insurance card. We will need this to verify your insurance before your appointment.

*Please note the Intake Packet is in a .pdf format, you will need a .pdf reader program such as Adobe Acrobat to open it. You can download Adobe Acrobat free at:
https://www.adobe.com/acrobat/pdf-reader.html

 


EAP INTAKE PACKET EXTRA PAGE
 

If you are an EAP client, please  complete the above INTAKE PACKET as well as this EAP INTAKE EXTRA PAGE. Please complete and return both to Tami Corn at tamicorn@yahoo.com or by Fax: 972-421-1816.