Fax number: 904-797-2820
Email: drtownsendoffice@gmail.com
Consent for Treatment and Client Information Form
This is the standard patient form that all new patients fill out prior to treatment. It is acknowledging the consent for treatment.
New Patients, 12 & Under Form
All new patients 12 and under must fill this form out, it provides the clinician basic background information on the client prior to the first appointment.
New Patients, 13 & Above Form
All new patients 13 and above must fill this form out, it provides the clinician basic background information on the client prior to the first appointment.
HIPPA Notice of Privacy Form
This form covers the rights of privacy of you, the patient, upon treatment.
Pre Surgical Evaluation Form
This form provides the clinician background medical information before the first meeting so we can give a thorough evaluation.
Bariatric Pre Surgical Evaluation Form
This form provides the clinician background medical information before the first meeting so we can give a thorough evaluation for Bariatric (weight loss) surgery.
Telehealth Consent Form
Telehealth in our practice involves the use of technology, either telephone or video to conduct diagnosis and therapy for those individuals who are unable access our office.
Ready to take the first step?
Contact us today -
Not quite ready? Read our FAQ page to see the most common questions about therapy answered.
St. Augustine, FL
Office: 904-797-2705
Fax: 904-797-2820
Email: drtownsendoffice@gmail.com
9 St. Johns Medical Park Dr., St. Augustine, FL 32086