FORMS

Completed forms should either be faxed to (814) 616-8884 or mailed by the US Postal Service to:       Andrews Institute, P.O. Box 9430, Erie, PA 16505

Mail delivered by FedEx or UPS (United Parcel Service) should be addressed to:

Andrews Institute, 4125 West Ridge Road, Erie, PA 16506

General Information Form

Medical History Form

Authorization for Release of Treatment Information

© 2019 by Andrews Institute for Addiction Treatment, LLC

4125 West Ridge Road, Erie, Pennsylvania 16506

www.addictionmedicinedoc.com

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