Please be sure to fill out the New Patient Paperwork in its entirety, once we receive this information our intake specialist will reach out to you to get your intake paperwork sent out through our secure patient portal. Should you have any questions, please reach out to our front desk at 505-242-6988, extension 108.

New Patient Paperwork

Patient Demographics

Type Of Phone *
May we leave a message? *
Address *
Address
City
State/Province
Zip/Postal

Insurance Information

Maximum upload size: 52.43MB
Maximum upload size: 52.43MB

Emergency Contact Information

May we leave a message? *

Medical Information

Address
Address
City
State/Province
Zip/Postal
Do you now or have you ever had any of the following medical conditions (check all that apply): *

Referral Information

What are you needing to be seen for? (select all that apply) *
Maximum upload size: 52.43MB
If you would like to request a specific therapist, click the link below to visit our staff page and get to know our therapists.


Meet Our Staff
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Please Select Preferred Therapist: