New Client Paperwork

To make a new appointment, please fill out the “Make an Appointment” form, or call the office at (919) 263-9592.

**The rest of this page is only for those who already have an appointment.**

Before your first appointment, please complete the form(s) below that applies to you. Please bring your driver’s license/form of ID and insurance card with you to the first appointment.

New Therapy or Testing Clients

Please click on one of the links below to fill out the New Client Paperwork.

ADULT PAPERWORK:
To Fill Out Online and Submit: Click Here To Fill Out New Adult Client Paperwork

To Print and Fill Out: ADULT New Client Paperwork

MINOR PAPERWORK:
To Fill Out Online and Submit: Click Here To Fill Out New Minor Client Paperwork

To Print and Fill Out: MINOR New Client Paperwork

PERSONAL HISTORY FORM:

To Fill Out Online and Submit: Fill Out Personal History Form Online

To Print and Fill Out: Patient Personal History Form – Electronic Version-1

GROUP THERAPY PAPERWORK: 
To Fill Out Online and Submit: Click Here To Fill Out Online Paperwork for Group Therapy

To Print and Fill Out: Group Therapy Client Agreement

To review the Perkins CPS Privacy Policy (HIPAA)- Click Here

To Print and Fill Out Our Release Form: Perkins CPS Release of Info


Bariatric Evaluation Clients

Please complete paperwork for BOTH links below before your appointment.

Bariatric Welcome Packet:
To Fill Out Online and Submit: Click Here to Fill out the Bariatric New Patient Form Online

To Print and Fill Out: Bariatric New Client Form -Welcome Packet

Weight and Lifestyle Inventory:
To Fill Out Online and Submit: Click Here to Fill out the Weight and Lifestyle Inventory

To Print and Fill Out: Weight and Lifestyle Inventory-Print Out Version

Contact Info

919-263-9592
Fax 919-263-9670
info@perkinscps.com

10580 Ligon Mill Road, Suite 210
Wake Forest, NC 27587

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