ALL
CLIENTS - FORMS FOR FIRST VISIT WITH THERAPIST
Please bring these forms with you to your first appointment.
Click on the appropriate file for download.
Patient Information Sheet – Complete this form |
| Disclosure Statement and Consent to Treatment Form - Read, Initial, Sign, and Date |
Notice of Privacy Practices (HIPAA) – Read Only |
Notice of Privacy Practices (HIPAA) Signature Page – Sign and Date |
ADULT
CLIENTS – FORMS FOR FIRST VISIT WITH THERAPIST
Please
bring these forms with you to your first appointment.
| Confidential Adult History Questionnaire – Complete this form |
CHILD/ADOLESCENT
CLIENTS – FORMS FOR FIRST VISIT WITH THERAPIST
Please
bring these forms with you to your first appointment.
| Confidential Child and Adolescent History Questionnaire – Parent completes form |
| Confidential Questionnaire for Adolescents – Adolescent completes form |
| Vanderbilt Assessment Scale - To be completed by parent |
| Vanderbilt Assessment Scale, Teacher Version - To be completed by teacher |
ADULT SUBSTANCE
ABUSE ASSESSMENTS AND/OR TREATMENT - FORMS FOR FIRST VISIT WITH THERAPIST:
Please complete
and bring
these forms with you to your first appointment.
| MAST – Complete this form |
| AUDIT – Complete this form |
ADOLESCENT SUBSTANCE
ABUSE ASSESSMENTS AND/OR TREATMENT - FORMS FOR FIRST VISIT WITH THERAPIST:
Please complete
and bring
these forms with you to your first appointment.
| AUDIT – Complete this form |
| AADIS – Complete this form |
RELEASE
OF INFORMATION
Please
complete this form if you would like your therapist to coordinate services or
communicate with other persons or agencies (i.e. school, physician, Social Services,
Probation, etc.) concerning your treatment or the treatment of your child.
| Release of Information For Confidential Medical Records – Complete this form |
 These
forms are in Adobe PDF format. Adobe's free viewer is available here. |