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

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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

Copyright © 2025 Foothills Consulting Associates - All Rights Reserved.

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