If you are an existing patient needing to update or add authorizations to your file, please select the appropriate option below. A new demographic form may be completed if you need to update your address, contact information, or insurance information.

If the patient is a minor, a parent/ guardian will need to complete the forms.


Demographic Information Form and Consent to Treatment

Demographic form - Adults
Demographic Form - Minors
Consent to Treatment - Adults
Consent to Treatment - Minors

Authorizations

Emergency Contact
Primary Care Provider
Previous Mental Health Provider
Blank Authorization

For Your Review

Notice of Privacy Practices
Crisis Management Plan
Patient Rights & Responsibilities