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Cincinnati - Forms


 

When you are ready to take your first step on the road to recovery, please complete the appropriate questionnaire form below and submit online to our secure server. If visiting via mobile phone or tablet, please choose the online form.

Your medical records assist us in tailoring your treatment to your specific conditions and circumstances. In order to release your medical records to Klarity, please complete and print the Authorization to Release Medical Records form below and forward to your managing professional.

 


Depression & Anxiety


Drug & Alcohol Addiction


Chronic Pain Patient Questionnaire


NAD+/IV Nutrient Therapy Questionnaire


Medical Records & Release

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