During the (COVID-19) epidemic, we are open for office visits and telemedicine visits

Online Forms

Adult Change Of Insurance Form

Adult Change Of Insurance Form

Adult Change Of Insurance Form

Here

Child Change Of Insurance Form

Adult Change Of Insurance Form

Adult Change Of Insurance Form

Here

Child New Year Update

Adult Change Of Insurance Form

Child New Year Update

Here

Adult New Year Update

Guardian Consent Update

Child New Year Update

Here

Self Consent Update

Guardian Consent Update

Guardian Consent Update

Here

Guardian Consent Update

Guardian Consent Update

Guardian Consent Update

Here

Address and Phone Change Form

Address and Phone Change Form

Address and Phone Change Form

Here

Forms Download

Fee Schedule and Policy Guide (pdf)

Download

Continuity and Coordination of Care Authorization and Release of Information (pdf)

Download

Private Pay Agreement (pdf)

Download

Records Request AUTHORIZATION TO DISCLOSE (pdf)

Download

Records Request AUTHORIZATION TO RECEIVE (pdf)

Download

Patient Privacy Directive (pdf)

Download

Vanderbilt Assessment Scales (pdf)

Download