I will no longer be taking new patients. Please check back here for more information.

Please click the links below to access the forms. We have utilized DocuSign Power Forms which will prompt you through the forms. The email may come from “Bess Heisler Ginty sent you a DocuSign”. Do not be alarmed. It is a valid email.

If you are interested in becoming a new patient, please complete the “Request for Service” power form. Once you click the link below, it will send you to a DocuSign Power Form. Please complete the entire document. Dr. Balk will contact you to confirm she will be able to accept you as a new patient.

Request for Service

Once Dr. Balk has confirmed acceptance as a patient, please complete the New Patient Information followed by the Adult OR Child Patient Questionnaire.

New Patient Information

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Adult Patient Questionnaire

Child Patient Questionnaire

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All clients must complete these forms PRIOR to first appointment.

Patient Responsibility Consent

Consent to Treat

Notice of Privacy Practices