Home

About Your
Therapist


About Our
Services


Location/Map

First
Appointment
Forms &
Information


Contact Us



   
Richard H. Stout
801 International Parkway, Ste 500, Lake Mary, FL 32746
Phone 407-323-0027 · Fax 407-322-0448

First Appointment Forms & Information

To make the best use of our time during your initial visit, please print out the New Patient Intake Forms, then select and print the appropriate Intake Questionnaire Form(s), fill out and sign them as needed, and bring them all with you to the office.

We will need a copy of your Driver's License and Insurance Card. If there is a co-pay or payment, please bring it with you to your visit. We accept MasterCard, Visa, Cash or Check.

It is not our general policy to place appointment reminder calls, so please make a note of your appointment date and time. Remember, this time is reserved just for you, so if you must reschedule or cancel an appointment, kindly give us 24 hour notice.

We look forward to meeting with you!

 

New Patient Intake Forms
      pdf

Intake Questionnaire
      *Adult pdf
      *Child/Adolescent pdf