New Patient Forms and Resources
(Please fill these out and bring them with you to your first appointment along with your Driver’s License, Insurance Card, and court paperwork if applicable)
Adult Intake Form
Child Intake Form
LENS Neurofeedback Forms (Please use your email address on file to login)
Telehealth Group Forms
Short Intake Form (use this form only if instructed)
Our Practice’s HIPAA Policy (Review Only)
Notice of Privacy Practices
Authorization to Release Protected Health Information
Credit Card Payment Form
Current Clients may schedule or cancel appointments via the client portal. If you do not yet have a portal account, please email firstname.lastname@example.org to request an account.
To have us verify your insurance, please fill out the form below at least 3 business days PRIOR to your appointment.
**Please note that insurance REQUIRES a diagnosis and this diagnosis becomes a part of your permanent medical record. By completing the form below, you are consenting to using your health insurance and providing diagnostic information to your insurance company. If you would like to know about receiving services without using insurance, please contact our offices.