Forms

Below you will find all of the forms that are used at the Practice. This includes our online forms and PDF versions of all of our intake forms as well.

Online Forms

  • NS/Late Cancellation Charge Form

    Use this form to report a NS/Late Cancel that you would like to charge for!

    Fill out form

  • Scheduling & Caseload Update Form

    Fill out this form any time there is a change in the status of your caseload (open for new clients, scheduling changes, etc)

    Fill out form

  • Medicaid Prior Authorization Form

    Fill out this form when you receive notification of a re-authorization needed through Theranest.

    Fill out form

  • 2024 Provider Payroll Form

    To access your payroll form click the link below.

    Fill out form

Printable Forms

Although these forms are available online through our EHR- Theranest, there are circumstances when we need the ability to print our intake forms. They can be found below.

PDF Intake Forms- English Version

PDF Intake Forms- Spanish Version

  • Consentimiento para Tratamiento Informado/Informed Consent for Treatment (2022) -(Spanish Version)

    Download

  • Derechos y responsabilidades del cliente/Client's Rights & Responsibilities- (Spanish Version)

    Download

  • Aviso de Prácticas de Privacidad/Notice of Privacy Practices- (Spanish Version)

    Download

  • Página de Firma del Plan de Tratamiento/Treatment Plan Signature Page- (Spanish Version)

    Downlodad

  • Consentimiento para solicitar/divulgar información personal y médica/ Release of Information (Spanish Version)

    Download

  • Cuestionario de Admisión de Clientes/Client Intake Questionnaire- (Spanish Version)

    Download

HR Forms

These forms are PDF forms that can be filled out and submitted directly through our website!

Submit Form