Forms
The forms below are to be completed after you have scheduled an initial appointment. Please go to our "Scheduling and Billing" page to learn how to schedule an appointment.
Please complete all six steps below (1. Informed Consent to Treatment, 2. Billing Consent, 3. Credit Card on File Authorization, 4. Intake Data Sheets, 5. Telepsychology Consent, and 6. Notice of Privacy Practices). If you click on the links to complete forms online, you will be redirected automatically to a secure site for each form. If you print and complete the forms by hand, please bring them with you to your first appointment. Thank you! (To print the forms you must have Adobe Acrobat Reader Installed. You may download this for free using the button at the bottom of the page.)
1. Informed Consent to Treatment
Click the link to fill out this form online, or click the button to print:
2. Billing Consent
Click the link to fill out this form online, or click the button to print:
3. Credit Card on File Authorization
Click the link to fill out this form online, or click the button to print:
4. Intake Data Sheets
Click the link to fill out this form online, or click the button to print:
