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.

Instructions for Form Submission

Step 1: Download Adobe Reader

adobe-reader
Download the latest version of Adobe Reader (free). Using third-party applications, including Apple’s Preview, can result in problems with your submitted forms. Using an outdated version of Reader can also result in problems with your form, so make sure you have the most current version.

Step 2: Download Forms Below

Right click on the form and select “save file as…”. Mac users, press and hold the Control (Ctrl) key while you click the form links. (The forms are not displayed correctly in most web browsers.) Open the form using Adobe Reader.

Step 3: Complete & Submit Forms

Fill out the form as completely as you can. If you can’t complete the signature field on a form, it can be signed in our office during your visit. Click the “Submit” button at the end of each form to send it to our office via our HIPPA compliant web service.

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)

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Note: Use of the website or interaction via email or form submission does not constitute a clinical or therapeutic relationship of any kind.