Forms

All of our forms can be completed online and electronically signed through our secure and HIPAA compliant format.

New clients must complete the “New Client Intake Form” only. Click the link below to access and compete. Thank you!

New Client Intake Form

Release of Information Form

Credit Card Authorization Form

GROUP FORMS

DBT Group Screening Form

DBT Referral Form (Individual Therapists)

DBT Release of Information Form

Consent to Group Therapy Telehealth

PSYCHIATRY FORMS

Universal Controlled Substance Prescribing Agreement

Lab Request Form

EVALUATION FORMS

Consent to ESA Evaluation

PHQ-9

GAD-7

PCL-5

MDQ

ProQOL5

AUDIT

EPDS

DERS

ASRS-5

ASRS-1

MacLean Borderline Personality Screener

Inferential Confusion Questionnaire

Y-BOCS-II

BAARS SR (Current)

BAARS SR (Childhood)

BAARS OR (Current)

BAARS OR (Childhood)

Notice of Privacy Practices