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Forms


Make a Referral: Use this form to make a referral to our practice. Self-referrals are welcome!


School Information Form: This form is intended for teachers who have students completing a psychoeducational or neuropsychological assessment in our office.


Therapy Consent Form - Adult: Complete this form if you or another adult will be seeing one of our psychologists for therapy.



Therapy Consent Form - Children and Adolescents: Complete this form if you are the parent or legal guardian of a child who will be seeing one of our psychologists for therapy.



Authorization for Release of Information - Adult: Complete this form if you would like us to release information about you to someone else.



Authorization for Release of Information - Children and Youth: Complete this form if you would like us to release information about your child to someone else.



Authorization for Release of Information - School Version: If your child will be completing an assessment with us, we usually gather information from the school. Your child's school may require this form before they release information to us.



Personal Health Information Act (PHIA): This document provides general information about the Personal Health Information Act (PHIA) and how we adhere to it in our office.