Forms

Financial Policy

Treatment Consent

HIPPA Consent Form

Advanced Counseling and Testing Solutions, LLC

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

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

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

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