NEW PATIENT FORMS: If you have been accepted as a new patient:
Complete and sign the following forms prior to your first visit. If
the primary focus of the service is for a child/youth
under 19 years of age, please complete the Child Paperwork and Family Inventory under the "Forms for Child Patient." If the primary services will be provided to someone
19 years of age or older, please complete the Adult Paperwork and Family Inventory under the "Forms for Adult Patient." If you are a patient returning to clinic after six months or
more, please complete the Paperwork under the "Forms for Returning Patient."
Forms for Child Patient: Forms for Adult Patient: Forms for Returning Patient: (Complete Both Forms) (Complete Both Forms)
Electronic: Child Paperwork Electronic: Adult Paperwork Electronic: Paperwork
Electronic: Family Inventory Electronic: Family Inventory
- OR - Print the forms below, complete and sign, and bring them with you to your first visit.
Print: Child Forms Print: Adult Forms Print: Update Forms
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DIVORCE CONSENT: If parents/guardians are separated or divorced, the Agreement for Child Psychotherapy with Separated or Divorced Parents/Guardians is to be signed by both parents/guardians:
Electronic: Divorced Parents Agreement -OR- Print: Divorced Parents Agreement
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RELEASE FORM: Complete this form to authorize release of psychotherapy information to/from other persons:
Electronic: Release of Information -OR- Print: Release of Information
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TELEHEALTH FORMS: Complete BOTH of the following consent forms before engaging in telehealth therapy:
Electronic: Telehealth Informed Consent -OR- Print: Telehealth Informed Consent
Electronic: Email and Text Consent -OR- Print: E-Mail and Text Consent
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ASSESSMENT AUTHORIZATION: Complete this form to authorize psychological
testing/assessments:
Electronic: Authorization for Assessment -OR- Print: Authorization for Assessment
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PRIVACY NOTICE: The Notice of Privacy Practices describes how psychological and medical information about you/your child may be used and disclosed:
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HANDOUTS: Helpful guidelines:
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