Evidence-Based Therapy & Medication Management to Help You Thrive

Forms

Feel free to review, print out, and fill out the required treatment forms below prior to your initial evaluation session:

For All Patients (Child & Adult):

1. Outpatient Services Contract
   
   
2. HIPAA Form
   
   
3. Authorization to Request Confidential Records Form
   
   
4. New Patient Registration Form
   
   
5. Credit Card Verification Form
   
   
6. Policies Information Form
   

Additional Consent Form for Child and Adolescent Patients:

1. Child Therapy Contract

For KIPP Students Only:

• Authorization Request
  
• Child Therapy Contract
  
• KIPP Initial Contract for Treatment
• New Patient Registration form for KIPP
• HIPAA Form