Helping people overcome their challenges
so they can live the life they were destined to live!
501(c)(3) Non-Profit Organization
Print & Manually
Fill in Forms
For your convenience and to save time before your first appointment, we have provided the required forms that you will need to complete for your first appointment. By completing the documents before you arrive, you prevent the need to arrive early for paperwork.
Directions for Printing & Manually Filling in Forms
Download/save the form files to your device (computer, phone, tablet):
a. Right-click the desired form
b. Select 'Save link as', name the file, and then select location on your computer where you want to save the file
c. Locate the downloaded form files (using PC File Explorer OR MAC Finder)
d. Double-click on the form files to open them
e. Print the form and then manually fill it in
f. Bring the forms with you to your first appointment
ADULT Client forms
Adult New Client Forms Packet - Print
Packet includes following individual forms:
1. Cover Letter
3. Authorization for Scheduling, Billing and Payment Purposes
5. PF1000 Notice of Privacy Practices
8. Notification & Coordination with
Primary Care Physician-Psychiatrist
LENS Neurofeedback forms
Adult
MINOR (Child/Adolescent) forms
Minor New Client Forms Packet - Print
Packet includes following individual forms:
1. Cover Letter
4. Authorization for Scheduling, Billing and Payment Purposes
6. PF1000 Notice of Privacy Practices
8. Child/Adolescent Intake form
9. Notification & Coordination with
Primary Care Physician-Psychiatrist
10. Notification & Coordination with Education Professionals