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Client Forms

Online and PDF Forms and Information

You may fill out and submit the New Client Information Packet online prior to your initial appointment to save time on the day of the appointment.  For clients under 18 you must complete the parent information as well.  Do not click “next” please go to each section and complete it.  

You will still need to bring proof of insurance on the day of your appointment.

If you would like medical records sent to another doctor’s office or to a school you can fill out our Release of information and submit it online. Note that therapy notes are not considered part of your medical records according to HIPAA Federal Guidelines.

Consent for non-legal guardian to bring minor for treatment form should be filled out if you would like for another adult to bring your child to an appointment. THIS MAY NOT BE USED FOR THE FIRST APPOINTMENT. It should be filled out completely and the original mailed or brought in to the office. It is required for a parent (or legal guardian who is primary caregiver) to attend the first session. There may be a delay in services if they are unable to make it to the first appointment.

Please complete and return these forms. Contact us.

NEW CLIENT Information

TELEMED Consent

RELEASE of Information

NO SHOW Policy

NON-LEGAL Guardian

Psychological Center Logo

Tips for a smooth visit.

Please download and read NOTICE and TESTING information.

CONSENT FOR CHILD Under 18

NOTICE of Privacy Practices

TESTING Information

• Arrive 15 minutes early for all visits.

• Bring your insurance card to your first visit and provide updated insurance information each time there is a change.  If you do not provide a copy of your insurance card you will be considered a self pay and required to pay the self pay rate in full on the day of your visit.

• Bring any pertinent records from schools or other providers.

• Have a complete list of all the client’s current medications and a list of any psychotropic medications previously prescribed.

• Be prepared to pay your copay or full amount of self pay rate.

• If there are any custody arrangements through the courts we will need a copy of the court decree to keep on file. It is the client’s responsibility to keep us informed of any custody changes.

• Make sure a parent or legal guardian attends the first appointment and signs a consent for any other adult to bring the child.

• We cannot speak to anyone on your behalf unless there is a signed Release of Information on file. This includes a spouse or parent of and adult (18 years or older) who is checking on an appointment or balance. We are more than happy to work with a relative or friend on your behalf but will require a signed Release of Information prior to providing any information. If you would like to add someone to your account please ask about a Release to keep on file. You may choose to limit that Release to appointments or billing only.

• All new clients for psychiatry require a referral from the most recent treating psychiatrist. If you have never seen a psychiatrist we will also accept a referral from your primary care provider.

• Many insurance companies are requiring referrals for services so you may be asked for this prior to scheduling an appointment.

• There is a $25 No Show fee for all appointmetns missed without a 24 hour notice.