New Patients Forms

If you have an intake scheduled with our clinic, please complete the paperwork on this page prior to your appointment. This will allow you more face to face time with your provider. Please still arrive to your appointment 10 minutes early. If you have any questions about the paperwork, please do not hesitate to contact our office.

 

Click the link below to download all the forms in one click! Pediatrics up to age 18 and Adult 18 and over.

Pediatric New patient forms

Adult New patient forms


Pediatric Forms.

DSM-5 Parent/Guardian Rated Child Age 6-17

DSM-5 Self-Rated Child Age 11-17

 

Adult Forms.

Adult Consent

Adult Care Agreement

DSM-5 Self-Rated Adult

 

Other Forms:

Release of Information (ROI)

HIPAA Notice of Privacy Practices

Annual Demographic Review

Patient Financial Hardship Application 


Psychological Testing Forms:

Consent for Psychological Assessment Services

Psychological Assessment Frequently asked questions

Referral Agencies for Additional Services:

Child, Teen and Young Adult Health Service Directory

Contact Us

Location

Availability

Monday:

9:00 am-5:00 pm

Tuesday:

9:00 am-5:00 pm

Wednesday:

9:00 am-5:00 pm

Thursday:

9:00 am-5:00 pm

Friday:

9:00 am-5:00 pm

Saturday:

Closed

Sunday:

Closed