Forms

At your first appointment (also called Intake), you will be filling out the following forms:  

            Authorization to Disclose

            Client Consent for Treatment

            Health Assessment

            Client Service Agreement

Additionally, here are some helpful downloads about a few of our key policies involving treatment - as well as some general insurance information.

Client Rights & Grievance Procedures

Notice of Privacy Practices

Our clinicians sometimes utilize the NICHQ Vanderbilt Assessment Scale to identify Attention Deficit / Hyperactivity Disorder. If your clinician has directed you to do so, please print out the following forms and fill them out according to their instruction. One is for a parent or guardian to fill out, the other is for a teacher to fill out.

Vanderbilt Assessment Scale - Parent Informant

Vanderbilt Assessment Scale - Teacher Informant

Medicaid, most insurances and private pay accepted. For more information, please call us at 419.475.4449