• Home
  • Services
  • Contact Us
  • Esketamine Treatment
  • Forms
    • New Patient Packet
    • Established Patient Form
  • More
    • Home
    • Services
    • Contact Us
    • Esketamine Treatment
    • Forms
      • New Patient Packet
      • Established Patient Form
  • Home
  • Services
  • Contact Us
  • Esketamine Treatment
  • Forms
    • New Patient Packet
    • Established Patient Form

New Patient Forms & Referral Forms

Please complete the forms and fax them to our office at 704-480-1832 or email them to fcashelby@gmail.com


2025 NEW PT PACKET (docx)

Download

Spravato Patient Referral Form (pdf)

Download

General Referral Form (pdf)

Download

Contact Us

Drop us a line!

Attach Client Contract
Attachments (0)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Foothills Consulting Associates

1610 East Marion Street, Ste. 250, Shelby, North Carolina 28150, United States

Phone: 704-480-1882 FAX: 704-480-1832

Hours

Open today

08:00 am – 05:00 pm

Foothills Consulting Associates

1610 E. Marion St. Suite 250, Shelby NC 28150, United States

Phone: 704-480-1882 FAX: 704-480-1832

Copyright © 2025 Foothills Consulting Associates - All Rights Reserved.

This website uses cookies.

We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.

Accept