MEA – Forms
Registration Form
Registration Sheet and Consent for Treatment
+ DOWNLOAD REGISTRATION FORM (pdf)
Notice of Privacy Practices
Copy of our Notice of Privacy Practices
+ DOWNLOAD NOTICE OF PRIVACY PRACTICES (pdf)
+ DESCARGAR AVISO DE PRÁCTICAS DE PRIVACIDAD (pdf)
Authorization To Release Medical Records
+ DOWNLOAD AUTHORIZATION TO RELEASE MEDICAL RECORDS (pdf) (Word Doc)
Registration Form
Registration Sheet and Consent for Treatment
+ DOWNLOAD REGISTRATION FORM (pdf)
+ DOWNLOAD MEA CARES EMPLOYEE ASSISTANCE PROGRAM–INFORMED CONSENT (pdf)
+ DOWNLOAD MEA CARES COUNSELING – INFORMED CONSENT (pdf)
Notice of Privacy Practices
Copy of our Notice of Privacy Practices
+ DOWNLOAD NOTICE OF PRIVACY PRACTICES (pdf)
+ DESCARGAR AVISO DE PRÁCTICAS DE PRIVACIDAD (pdf)