When you request an appointment for therapy, assessment or group, you will be asked to complete the New Patient Information Form. We use this to ensure that we have your most accurate contact information and to verify insurance coverage if you will be using insurance. We can email the form to you, or you can download it below, complete it, and return it to us. For your convenience, we have included both Microsoft Word (fillable form that can then be printed) and PDF (form can be printed then completed with black or blue ink pen) versions of the New Patient Information Form. Complete only 1 version of the form. Please note that the Microsoft Word file will automatically download to your computer.
You will also be asked to compete the Credit Card Authorization Form. We require this form for all patients, whether they are using insurance or paying out of pocket. This is to ensure payment for all appointments and to encourage attendance at the intake and subsequent appointments, as we charge a no show fee of $50 per scheduled hour. In order to confirm your intake appointment, we ask that you return both the New Patient Information Form and the Credit Card Authorization Form to us within 24 hours of scheduling the appointment or the time the email is sent to you, whichever is later.
All patients/caregivers will need to complete the Informed Consent in order to be seen for any service. You may complete the Informed Consent and bring it to your first appointment.
Please note, the Informed Consent for Patients with Legal/Custody Issues is only for patients/families that have a custody arrangement or for patients who are in foster care or in the care of a non-biological parent. In these cases, please complete BOTH consent forms. For patients with a legal or custody arrangement, ALL parents/legal guardians who have the right to make medical decisions will need to complete and sign BOTH consent forms and return them to us by email or fax BEFORE the intake appointment can be scheduled. This is to ensure that all individuals who have legal decision-making power are informed and in agreement about your child engaging treatment.
You may complete the following forms and bring them to your first appointment. If you do not wish to complete the forms ahead of time, please arrive 30 minutes early for your first appointment so that you will have time to complete the additional paperwork.