Telehealth Appointments Available
New Patient Information with Parent or Guardian
Información de Pacientes (Adultos)
Consentimiento del Tutor Legal para el Tratamiento
Políticas de la Oficina y Formulario de Consentimiento
Política de Comunicaciones con el Paciente
Consentimiento Informado para Servicios de Salud Telemental
Acuerdo Financiero para la Salud Telemental
ROI Autorización para la Divulgación de Información Protegida
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.
HIPAA Notice of Privacy Practices
Notice for the No Surprises Act: You have the right to receive a good faith estimate of expected charges.
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 scheduling@alli-center.com. 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
ASRS: Adult ADHD Self-Report Scale Symptom Checklist