top of page

Client Forms and Information

STANDARD NOTICE: Right to Receive a Good Faith Estimate of Expected Charges Under the No Surprises Act

 

To expedite the check-in process at your first appointment, please print and complete the appropriate forms to bring with you.

​

Adults

Adult Intake Forms

Adult Consent to Receive Services

Telehealth Informed Consent

Credit Card Authorization

Authorization to Release Protected Health Information: Required for referrals and/or release of psychological assessment/evaluation information to another provider (physician, psychiatrist, etc.).

​

Children and Adolescents

Child and Adolescent Intake Forms

Child and Adolescent Consent to Receive Services

Telehealth Informed Consent

Credit Card Authorization

Authorization to Release Protected Health Information: Required for referrals and/or release of psychological assessment/evaluation information to another provider (physician, psychiatrist, etc.).

​

bottom of page