Call Us Today! (833) You-Talk
DOWNLOADABLE FORMS
As a convenience to our clients and colleagues, we have made available certain client forms used by our office.
DO NOT SUBMIT THESE FORMS TO US ELECTRONICALLY.
CLIENT SHOULD BRING INTAKE FORMS WITH THEM TO OUR OFFICE.
CLIENT SHOULD BRING INTAKE FORMS WITH THEM TO OUR OFFICE.
INTAKE FORMS
Save time when you visit our office by downloading and completing our intake forms.
Complete these forms in the comfort of your own home, instead of our waiting area.
Complete these forms in the comfort of your own home, instead of our waiting area.
|
Intake Form
|
| ||
|
Authorization to Release
|
| ||
|
Biopsychosocial Form
|
| ||
|
Consent to Treat Form
|
| ||
|
Credit Card Authorization
|
| ||
CRIME VICTIMS INVOICE FORM
Completed by providers on behalf of crime victims or the family members of crime victims.
|
Crime Victim Invoice Form
|
| ||
REFERRAL FORM FOR MENTAL HEALTH SERVICES
Used for patient referrals . Referring party should make sure to have patient complete the authorization to release form. Please send a copy of the authorization to release form, along with discharge summary, or recent psychological/psychiatric evaluation with this referral form to us.
|
Referral Form
|
| ||
|
Authorization to Release
|
| ||