Phone Number: (509) 456-3600
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Patient Forms

Prior to your initial appointment with us, all patients must complete and submit the forms from the appropriate section below. This allows our team to review the information before your visit so we can make your time with us productive and effective.

Please use the free Adobe Reader application to fill out and submit your forms: http://get.adobe.com/reader/

For Mac Users: DO NOT use the “Preview” application in your browser to complete these forms, as an incompatibility causes the forms to be blank when opened on other computers. Please use the free Adobe Reader application: http://get.adobe.com/reader/

THERAPY PATIENTS:

Therapy patients should download, complete, and submit these forms.

- New Patient Information Form (PDF)
- HIPAA Acknowledgement (PDF)
Outpatient Services Contract (PDF)
- Parent Consent to Give Up Access to Child’s MH Records (PDF)
 

CHRONIC PAIN EVALUATION PATIENTS: 

Chronic pain evaluation patients should download, complete, and submit these forms.

Adult History Form for Pain Evaluations (PDF)
- New Patient Information Form (PDF)
Outpatient Services Contract (PDF)
Pain Evaluation Consent Form (PDF)
- HIPAA Acknowledgement (PDF)

TESTING PATIENTS (18 years and older):

Testing patients (18 years and older) should download, complete, and submit these forms.

- Adult History Form (PDF)
- New Patient Information Form (PDF)
Outpatient Services Contract (PDF)
Consent for Evaluation (PDF)
- HIPAA Acknowledgement (PDF)

TESTING PATIENTS (under age 18):

Testing patients (under age 18) should download, complete, and submit these forms.

Child and Adolescent History Form (PDF)
- New Patient Information Form (PDF)
Outpatient Services Contract (PDF)
Consent for Evaluation (PDF)
- HIPAA Acknowledgement (PDF)
- Age 13-17 Release of Information (PDF)