This is a new patient questionnaire for addiction patients. Please download this form and spend the time completing it if we have asked you to do so. The questionnaire will help us have a thorough understanding of your care needs.

This is a copy of the release of information for Earley Consultancy. This form must be filled out completely before our office can contact an outside party. Down load it here. Read the instructions on the release form and fill in all blanks before sending it back to us. When it is complete you can fax it back to us at our fax number: 855-344-7918.