Sprint To Success
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Patient Intake

Forms & Payment

Patient Intake Forms

 

 
 
Telehealth Form
Confidentiality Release Form
 
New Client Intake Form
Confidentiality Exchange Form
 

 

Online Payment Options

All payments must be made in full prior to the start of your session.

What forms of payment are accepted?

We accept payments via PayPal and Venmo. Click either of the links below to select a payment option.

 
Venmo
Paypal

Or you can use the QR code to submit payment.