Patient Forms

Please download, print out, complete these forms, and bring them with you to the office.

All forms are in PDF format. A free PDF reader can be downloaded here.

New Patient Forms

Includes . . . 

• Intake for Mental Health Form
• Practice Policies Disclosure Form
• New Patient Questionnaire

› Download

Additional Patient Forms

• Release of Information  › Download
• Sexual Health History Men  › Download
• Sexual Health History Women  › Download

Take the First Step

Let’s explore how you can have the life and relationships you want. 207.749.9116 or yara@yaraperez.com.
NOTE: Yara tries to return emails within 2 business days. If, however, you do not hear from her, feel free to contact her again.