Lancaster: 717-208-6599 Wyomissing: 484-987-7116

Patient Privacy Act (no need to print
for your reference only)

Treatment Consent

Forms

HIPPA Consent Form

Release of Health Care Information
(please include referring physician, spouse, etc.)

Financial Policy

Please print and complete the above 5 forms (excluding the Patient Privacy Act, this is for informative purposes only) prior to your appointment at ACTS. This will help to eliminate unnecessary wait time in the reception area.

Thank you!

Adult Intake Form

Advanced Counseling and Testing Solutions, LLC