Tides Of Life
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Forms

The following links are to forms that must be completed by new clients. The forms in BLUE can be completed and submitted online. Alternately, the forms in ORANGE can be downloaded, completed and brought to the office.

Beach Scene

A password will be provided when you schedule your appointment which will allow you to access the links.

During the COVID-19 pandemic, we will be providing all services remotely, therefore new clients must complete and submit all BLUE forms before services can be provided.

Clients planning on using Insurance as a form of payment should review the Tides of Life Insurance Checklist to better understand possible coverage.

If you have questions or problems, feel free to contact the office at 317-398-8361 for assistance.

Telemedicine Informed Consent Form (PDF)
Telemedicine Informed Consent Form (Online)

Consent For Services Form (PDF)
Consent For Services Form (Online)
New patients need to complete this form before their first visit.

Client Symptom Checklist (PDF)
Client Symptom Checklist (Online)
New patients need to complete this form and bring it to their first visit.

Client Information Form (PDF)
Client Information Form (Online)
New patients need to complete this form and bring it to their first visit.

Release Of Information Form EAP/Insurance (PDF)
Release Of Information Form EAP/Insurance (Online)
This form needs to be completed to allow Tides Of Life to exchange information with others.

Tides Of Life Insurance Checklist (PDF)
This checklist can help you collect and understand your insurance coverage.

Our Privacy Policy (PDF)
Our Privacy Policy (Online)
New patients need to complete this form before their first visit.

OPTIONAL

Release Of Information Form (PDF)
Release Of Information Form (Online)