Patient Forms


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  1. New Patient Demographic Informationclick 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 Formclick here
    (Adult Initial Evaluation for all new Adult Patients to complete and sign prior to appointment.)
  4. Permission to Treat Childclick here
    (For new child patients, parents signature required.)
  5. Child Evaluation Formclick 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 Informationclick here
  8. Medicare Agreementclick here
  9. Credit Card Authorization –  click here