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Patient Forms

Please complete ALL FORMS in this category if you are a NEW THERAPY PATIENT:

 

- Patient Information Form (pdf)

- HIPAA Acknowledgement (pdf)

Outpatient Services Contract (pdf)

- Parent Consent to Give Up Access to Their Child’s Mental Health Records (pdf)

 

Please complete ALL FORMS in this category if you are a NEW GROUP THERAPY PATIENT:

 

Patient Information Form (pdf)

HIPAA Acknowledgement (pdf)

Outpatient Services Contract  (pdf)

Please complete ALL FORMS in this category if you are a NEW TESTING PATIENT (18 years and older)

 

- Adult History Form 2014 (pdf)

- Patient Information Form (pdf)

Outpatient Services Contract (pdf)

Consent for Evaluation (pdf)

HIPAA Acknowledgement (pdf)

Please complete ALL FORMS in this category if you are a NEW TESTING PATIENT (under age 18):

 

Child and Adolescent History (pdf)

- Patient Information Form (pdf)

- Outpatient Services Contract (pdf)

- Consent for Evaluation (pdf)

- HIPAA Acknowledgement (pdf)

- 13 yr. Old Release on Info. Consent (pdf)

Please complete ALL FORMS in this category if you are a LEGAL CASE:

 

Patient Information Form (pdf)

Therapy Consent and Contract (pdf)

Evaluation Consent and Contract (pdf)