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