Forms and Information

Registration forms

• Patient Information
• Authorization to Release Medical Information (English and Spanish forms available)
• Patient Responsibility for Payment
• Patient's Right to Appeals and Grievances
• Notice of Privacy Practices (English and Spanish forms available)
• Consent to Use Telehealth Services

Adult patient forms

• Health History
• New Patient Medication Management Form
• New Patient Therapist Form
• Patient Health Questionnaire
• Generalized Anxiety Disorder Scale
• Symptom Checklist

Child and adolescent patient forms

• New Patient Medication Management Form
• Family Demographics

Spanish Forms and Information

Registration forms

• Patient Information - Spanish
• Patient Responsibility for Payment - Spanish
• Patient rights to appeals and grievances - Spanish
• Consent to Use Telehealth Services - Spanish

Adult patient forms

• Health History - Spanish
• New Patient Medication Management Form - Spanish
• New Patient Therapist Form - Spanish
• Patient Health Questionnaire - Spanish
• Generalized Anxiety Disorder Scale - Spanish
• Symptom checklist - Spanish

Child and Adolescent patient forms

• New Patient Medication Management Form - Spanish
• Family Demographics - Spanish