FORMS AND RESOURCES

Patient Forms

New Patient Packets - Choose the age bracket of the patient to open the appropriate forms to print and fill-out.

Please remember to take your completed forms and arrive at least 15 minutes prior to your first visit.

  • Adults (Age 18+ years old)
  • Adolescents (Age 13-17 years old)
    • Child/Adolescent Patient Registration (English) (Spanish)
    • Psychosocial History for Children/Adolescents (English & Spanish)
    • About Myself
    • Notice of Patient’s Rights and Responsibilities, and Privacy Practices as required by the Health Insurance Portability and Accountability Act (HIPAA) OF 1996 (English) (Spanish)
    • Acknowledgement regarding Cancelled and Missed Appointments (must be signed by legal guardian) (English & Spanish)
    • Release of Information Authorization (must be signed by legal guardian) (English) (Spanish)
  • Children (5-12 years old)
    • Child/Adolescent Patient Registration (English) (Spanish)
    • Psychosocial History for Children/Adolescents (English & Spanish)
    • About Me
    • Notice of Patient’s Rights and Responsibilities, and Privacy Practices as required by the Health Insurance Portability and Accountability Act (HIPAA) OF 1996 (English) (Spanish)
    • Acknowledgement regarding Cancelled and Missed Appointments (must be signed by legal guardian) (English & Spanish)
    • Release of Information Authorization (must be signed by legal guardian) (English) (Spanish)
  • Patient Guide (English) (Spanish)
  • Coordination of Insurance Benefits (English & Spanish)

Screening Tools – These are not intended to replace professional clinical judgement. CONSULT A PROFESSIONAL CLINICIAN for proper diagnosis.

Provider Forms

Network Enrollment

Clinical Forms

Psychiatrist/MD/DO or Psychiatric Physician’s Assistant