Please print, complete and bring the appropriate forms with you to your appointment.  Note: Original printed versions of the forms are required to scan into our electronic medical record. Photocopy versions will not scan properly. 

New Patient - Medicare

• Facesheet/Demographics
• HIPAA
• Medicare Health Risk Assessment
• PHQ-9
• New Patient History

Established Patient - Medicare

• Facesheet/Demographic
• HIPAA
• Medicare Health Risk Assessment
• PHQ-9

New Patient  - Commercial Insurance

• Facesheet/Demographic
• HIPAA
• New Patient History Form
• PHQ-9 (if over age 50)

Established Patient - Commercial Insurance

• Facesheet/Demographics
• HIPAA
• PHQ-9 ( if over age 50)

Authorization For Use or Disclosure of Protected Health Information
Authorization For Use or Disclosure of Psychotherapy Notes