Patient Forms

Please use our Patient Portal to fill out and submit your forms online before your appointment. Completing them in the portal is the preferred method for your forms and will help expedite your appointment. To use our Portal is easy. Simply create an account at the office or by phone and login to access the forms.

Please note that the forms are held pending until your check in for your appointment. They will be removed from your account if you do not keep your appointment.

Patient Forms

Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.

Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. AutorizaciĆ³n y Consentimiento Para el Tratamiento

Preferred Contacts (PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos

Virtual Visit Policy (PDF) - This policy describes the process for the documentation, maintenance, and transmission of information using virtual visit technology.

Psychotherapy Forms

Office Policies and Procedures

Client Registration

Informed Consent for Psychological Services

Statement Of Understanding for Telephone Conferences

Client Background Information

Policy on Sharing Info About Child Clients With Courts

Informed Consent Adults 18+

Informed Consent for Psychological Testing

Waiver of Privilege

Office Policies

Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.

Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.

HIPAA Privacy Notice