Patient Forms

  1. Required Forms – This packet includes every form that is legally required to start therapy for a fully licensed therapist.
    • a. Telehealth Informed Consent/Agreement for Services
    • b. Notice of Policies and Practices Regarding Privacy of Health Information-HIPAA,
    • c. Clinical Professional Agreement for Services

    Click here to download

  2. Required Forms Provisionally Licensed Therapist – This packet includes every form that is legally required to start therapy for a provisionally licensed therapist.
    • a. Telehealth Informed Consent/Agreement for Services,
    • b. Notice of Policies and Practices Regarding Privacy of Health Information-HIPAA,
    • c. Clinical Professional Agreement for Services

    Click here to download

  3. Telehealth Informed Consent/Agreement for Services: Click here to download
  4. Release of Information: Click here to download
  5. Clinical and Professional Agreement for Services: Click here to download
  6. Notice of Policies and Practices Regarding Privacy of Health Information (HIPAA): Click here to download
  7. Full Adult Intake Packet: Click here to download
  8. Full Child Intake Packet: Click here to download
  9. Provisionally Licensed Full Adult Intake Packet: Click here to download
  10. Provisionally Licensed Full Child Intake Packet: Click here to download
  11. COVID-19 Policies and Procedures: Click here to download
  12. Payment Agreement: Click here to download
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