Please print, review and complete all forms prior to your appointment; if you are unable to do so please be prepared to arrive at least thirty minutes prior to your scheduled appointment to do so in our office.

Therapy paperwork with insurance

• Counseling Intake Paperwork
• Treatment Consent Form
• Authorization for use or disclosure of protected health information
• Insurance information & agreement
• Policy acknowledgement form
• Financial Policy
• Medication Policy
• Practice Policy

Therapy paperwork without insurance

• Counseling Intake Paperwork
• Treatment Consent Form
• Authorization for use or disclosure of protected health information
• Insurance waiver agreement
• Policy acknowledgement form
• Financial Policy
• Medication Policy
• Practice Policy

Appointment with a Psychiatrist or Board Certified Nurse Practitioner with insurance

• Adult Patient Information Sheet: for individuals 18 and older
• Minor patient information sheet: for individuals under age 18
• Health History
• Treatment Consent Form
• Authorization for use or disclosure of protected health information
• Insurance information & agreement
• Policy acknowledgement form
• Financial Policy
• Medication Policy
• Practice Policy

Appointment with a Psychiatrist or Board Certified Nurse Practitioner without insurance

• Adult Patient Information Sheet – for individuals 18 and older
• Minor Patient Information Sheet – for individuals under age 18
• Health History
• Treatment Consent Form
• Authorization for use or disclosure of protected health information
• Insurance waiver agreement
• Policy acknowledgement form
• Financial Policy
• Medication Policy
• Practice Policy

ADHD and Children

• What is ADHD?
• Stimulant ADHD Medication Heart History
• Examples of Possible Accommodations/Interventions for a 504 plan
• Teacher Letter
• NICHQ Vanderbilt Assessment Scale (parent)
• NICHQ Vanderbilt Assessment Scale (teacher)

Medical Nutrition Therapy

• Nutrition Assessment adult and minor
• Nutrition Assessment during Pregnancy
• Treatment Consent Form
• Patient Acknowledgement
• Practice Policy

Referrals for Psychological Testing

• List of local Psychologists