Patient Forms

Adobe

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  1. New Patient Demographic Information – click here
    (For new patients to complete and bring to the first appointment.)
  2. Statement of Understanding (Psychotherapy Agreement) – click here
    (Adult or parent should sign the last page and bring to the office visit.)
  3. Adult Evaluation Form – click here
    (Adult Initial Evaluation for all new Adult Patients to complete and sign prior to appointment.)
  4. Permission to Treat Child – click here
    (For new child patients, parents signature required.)
  5. Child Evaluation Form – click here
    (For new child patients, parents complete.)
  6. Health Information Protection and Portability (HIPPA) – click here
    (These are the HIPPA regulations describing patient confidentially.)
  7. Permission to Release Treatment Information – click here
  8. Medicare Agreement – click here
  9. Credit Card Authorization –  click here