Forms & Policies

Note: the links above are for PDF files. Please click the link you need, then print the form out on paper and sign it with a pen. Do not attempt to open them as documents and make changes to them electronically, as they will not be valid.

Disclosures that Do Not Need to be Signed

HIPAA Notice of Privacy Practices

Notice for the No Surprises Act: You have the right to receive a good faith estimate of expected charges.

Optional Screening Assessments

Your provider may ask you to fill out one or more of these forms.  If that is the case, please print it, fill it out, scan it, and email it to us at If you do not have access to a scanner, please discuss other options with your provider.

PHQ-9: Patient Health Questionnaire

GAD-7: Generalized Anxiety Disorder Screener

AUDIT: Alcohol Screen

ASRS: Adult ADHD Self-Report Scale Symptom Checklist

NICHQ Vanderbilt Assessment Scale - Parent Informant

NICHQ Vanderbilt Assessment Follow-up - Parent Informant