Forms
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Last Updated: Jan 23, 2025, 01:18 PM
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Our Forms
Registration Forms
- HIPAA (Fillable PDF)
- Medicaid Waiver (Fillable PDF)
- Consent to Electronic Communications (Fillable PDF)
Intake Forms
- Informed Consent to Record (Filliable PDF)
- Information and Consent for Treatment (Fillable PDF)
- Informed consent regarding use of telehealth (Fillable PDF)
Documents and Forms
- Informed Consent to Record (Filliable PDF)
- Information and Consent for Treatment (Fillable PDF)
- Therapist-Client Agreement (Fillable PDF)
- Information and Consent to Participate in Therapy as a Collateral Person to Treatment (Fillable PDF)
- Information and Consent to Psychological Services (Fillable PDF)
- Authorization for Psychological Evaluation (Fillable PDF)
- Informed consent regarding use of telehealth (Fillable PDF)
- Clinical Center Release of Information (Fillable PDF)
- Clinical Center Release of Information - Instructions (PDF)
- Safety Plan (Fillable PDF)
- Instructions for Clients to access Zoom (PDF)
- Zoom Video Instructions for Clients (MP4)
- Reduced Fee Application (Fillable PDF)