Forms & Policies

Please print, fill in, and sign these forms to bring with you on your first visit.

Note: the below links 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 this will not be valid.

View our HIPAA Notice of Privacy Practices (this does not need to be printed or signed)

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 send it back to us through our patient portal. 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