Advanced Therapy Center
Dr. Mark Lovinger
(216) 378-7633

Client Forms

If you are a new client, please download the forms below. The Privacy Notice and Service Agreement are for you to read and keep for your records. Please bring the completed Intake Form and the signed Signature Form with you to your first appointment. The Signature form states that you have read the Service Agreement and Privacy Notice.

Bring your insurance information, including claims address.

Copays are due at the time of your appointment.

**Please note: Certain treatment modalities and all legal/court related evaluations are typically not covered by insurance companies

  • Client Intake Form - pdf
  • Service Agreement & Privacy Notice - (available soon)
  • Signature Form - (available soon)
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