New Patient Intake Forms
The fastest way: complete everything online in one guided, secure packet. It works on your phone, tablet, or computer. Prefer paper? The printable forms are below.
Complete your intake online, about 20 to 30 minutes
One guided packet covers registration, health history, and every consent form, with electronic signature. Your answers are encrypted before anything is sent. No account or portal needed.
Start the Online Intake Packet →Patient Registration
Personal information, emergency contacts, and insurance details.
HIPAA Notice of Privacy Practices
Your rights under HIPAA and how we protect your health information.
Informed Consent for Treatment
Risks, benefits, and your rights regarding psychiatric treatment.
Informed Consent for Telehealth
Consent specific to receiving care via telehealth video appointments.
Financial Policy
Payment expectations, fees, cancellation policy, and billing procedures.
Minor Patient Consent
Required when a parent or guardian is consenting to treatment on behalf of a minor (under 18).
42 CFR Part 2: SUD Records Consent
Federal consent form required to share or receive records related to substance use disorder treatment.
Controlled Substance Agreement
Required if your treatment plan may include controlled substances (e.g., stimulants, benzodiazepines).
Authorization for Release of Information
Authorizes us to share or receive records with another provider, insurer, or third party of your choosing.
Ready to book your first visit?
Once your forms are complete, schedule your initial evaluation, 60 to 75 minutes via telehealth.
Schedule Your First Appointment →