Forms

Forms

Adults: Read the Adult Client Consent. (The HIPAA document is also available to you to review). Print and fill out the Adult Client Questionnaire and the Finance Agreement, and bring both to your first office visit.

Note that you do not have to print the Adult Consent  but confirm that you have been made aware of the consents with a “check” on the bottom of the Adult Client Questionnaire. For your convenience, a copy of the Adult Client Information Questionnaire is available to you in both a Word Document and PDF format- you may use either one.

Parents of adolescents/adolescents: Read the Adolescent.Parent Consent. (The HIPAA document is also available to you to review). Print and fill out the Adolescent.Parent Questionnaire and the Finance Services Agreement, and bring both to the first office visit.

Note that you do not have to print and bring the Adolescent.Parent consent document, but please confirm that you have been made aware of the consents by putting a confirmation “check” on the bottom of the Adolescent.Parent Questionnaire. For your convenience, a copy of the Adolescent.ParentQuestionnaire is available to you in both a Word Document and PDF format- you may use either one.

HIPAA 

AdultClientConsent

Financial Services Agreement

Adult Client Information Questionnaire (PDF)

Adult Client Information Questionnaire (Word Document)

Adolescent.ParentConsent

Adolescent.ParentQuestionairre (PDF)

Adolescent.ParentQuestionairre (Word Document)