Forms

New & Returning Patients

Psychotherapeutic-Resources-flower-logo

For your convenience, print and complete the relevant forms prior to your first meeting

New Clients

Please complete all pages and bring to your first meeting

Adults

Administrative Intake Form

Clinical Intake Form

Symptom Checklist

Billing Consent Form

Telehealth Consent

Informed Consent Covid

Children

Administrative Intake Form-Child

Clinical Intake Form

Minor Consent Form

Safe Harbor Agreement

Child Intake Checklist- Parent Form

Child Intake Checklist- Child Form (11-17 years)

Billing Consent Form

Telehealth Consent

Informed Consent Covid

Returning Clients

Please complete all pages and bring to your first meeting

Adults

Administrative Intake Form

Clinical Intake Update Form

Symptom Checklist

Billing Consent Form

Children

Administrative Intake Form-Child

Child Clinical Update Form

Checklist-Parent Form

Checklist-Child Form (11-17 years)

Billing Consent Form

Optional Form

A voluntary form, necessary if you would like to send your information to a named source or to have us to receive information from a named source.  Sign and bring as desired.

Authorization to Release Protected Health Information