Phone Number: (509) 456-3600
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Patient Forms

The following is a list of required new patient forms.

New Therapy Client Forms

- 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)

New Testing Client (over 18) Forms

- Adult History Form (pdf)

- Patient Information Form (pdf)

Outpatient Services Contract  (pdf)

Consent for Evaluation (pdf)

HIPAA Acknowledgement (pdf)

New Testing Client (under 18) Forms

- Child and Adolescent History Form (pdf)

- Patient Information Form (pdf)

- Outpatient Services Contract (pdf)

- Consent for Evaluation (pdf)

- HIPAA Acknowledgement (pdf)

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

Legal Cases Forms

Patient Information Form (pdf)

Therapy Consent and Contract (pdf)

Evaluation Consent and Contract (pdf)