Practice Forms

Please click on links below to access our practice forms

Child Intake

Please complete if the patient is a child/teen under 18 years of age. If the patient is a child/teen, legal guardians will need to complete the Adult Intake Registration Form with their own information as well as the Child Intake Registration Form with the patient's information.

Child Registration Form

Adult Intake

Please complete if the patient is an adult over 18 years of age. If the patient is a child/teen, legal guardians will need to complete this form with their own information as well as the Child Intake Registration Form with the patient's information.

Adult Registration Form

Clinical Information Form

Please complete this optional form to provide your clinician with additional information about you (or the patient).

Clinical Information Form

Authorization to Release Information/Records

Please complete this form for anyone who needs to be involved in treatment, such as physicians, family members, attorneys, etc. The form must be completed in its entirety to be considered valid. One form should be completed for each individual authorized for communication/records and for each patient.

Authorization for Release of Information/Records

Phone: (317) 572-1313