Forms

If you are a new client/patient and wish to register for services, please complete the following forms: 1. Insurance and Billing Pre-authorization Registration, 2. Client/Patient Intake Form, 3. Credit Card Authorization From. This will help us expedite your request. Our billing manager will email you with your pre-authorization and our intake coordinator will call you to discuss matching you with a therapist. You can also give us a call if you need any assistance. 

Registration Forms:

• Insurance and Billing Pre-Authorization Registration Form
• Credit Card or Check Authorization Form
• Client/Patient Intake Form
• Coaching Intake Form

Couples Forms:

• Marital Counseling Initial Intake Form
• Guidelines and Agreements for Couples Counseling

Authorization Forms:

• Authorization to Disclose Information Form
• CBD Waiver

Preoperative Evaluation Form:

• Preoperative Psychological Evaluation Questionnaire Form

• HIPAA Authorization to Disclose Information (For Your Referring Provider)

For Groups please complete the following forms:

*Please go to the Group page to select your group session.

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