Please print, read, sign, and bring to your office visit Consent to Treatment Consent to Treatment - English(opens in a new tab) Consent to Treatment - Portuguese(opens in a new tab) Consent to Treatment - Spanish(opens in a new tab) Financial Obligation Financial Obligation - English(opens in a new tab) Financial Obligation - Portuguese(opens in a new tab) Financial Obligation - Spanish(opens in a new tab) HIPAA-Consent to Disclose HIPAA-Consent to Disclose - English(opens in a new tab) HIPAA-Consent to Disclose - Portuguese(opens in a new tab) HIPAA-Consent to Disclose - Spanish(opens in a new tab) Non-Covered Service Waiver Non-Covered Service Waiver - English(opens in a new tab) Non-Covered Service Waiver - Portuguese(opens in a new tab) Non-Covered Service Waiver - Spanish(opens in a new tab) Consent to Obtain Prescription History Consent to Obtain Prescription History - English(opens in a new tab) Consent to Obtain Prescription History - Portuguese(opens in a new tab) Consent to Obtain Prescription History - Spanish(opens in a new tab)