New Client Forms

If you are a new client of InterPlay, please fill out the following forms prior to your first visit with us.

InterPlay is located in West Palm Beach and caters clients from all over Palm Beach County; from Wellington, Boca Raton, West Palm Beach, Jupiter, and more.

  1. Individual History Record (Please, make sure to complete all 5 pages)
  2. Release and Waiver of Liability
  3. Information Release Form
  4. Notice of Privacy Act (HIPPA)
  5. Cancellation Policy
  6. Credit Card on File Agreement
  7. Payment Policy
  8. Emergency Treatment Authorization
  9. Waiting Room Confidentiality Agreement
  10. Photo / Video Release Form

Completing ALL these forms BEFORE your first visit will ensure a fast intake on your apportionment day.

We are honored you chose us to be part of your child’s future!