Forms

Thalia Medical Center Forms


Please click on the form you're looking for below. You will be redirected to complete the signing process using a secure website (IntakeQ). If you have any issues, please email [email protected] Thank you!


New Client Intake (complete set of forms)


Individual Forms:

Credit Card Authorization

Authorization to Disclose Protected Health Information


Location

Hours of Operation

Monday:

9:00 am-5:00 pm

Tuesday:

9:00 am-6:00 pm

Wednesday:

9:00 am-5:00 pm

Thursday:

9:00 am-5:00 pm

Friday:

1:00 pm-5:00 pm

Saturday:

Closed

Sunday:

Appointment Only