Forms & Questionnaires

Most of our forms will be sent via our client portal. If you need help accessing this, please email us at contact@hopesprings.net.

NEW CLIENTS: please complete our New Client Request form. This form does not guarantee an appointment. Our staff will review the information with our providers and will contact you if we are able to schedule.

New Client Request

Intake Forms

Please do NOT complete these forms unless you are told to do so.

• Consent for Services
• Adult Intake
• Notice of Privacy Practices

Release of Information

*Once we have a Release of Information (ROI) form on file, we are able to send information to the person you put on the form. Please complete separate forms for each clinic or provider.

• Release of Information (ROI)*
• Release of Information (Self)
• Release of Information (Parent/Legal Guardian)

Questionnaires

Please do NOT complete these forms unless you are told to do so.

• Teacher Questionnaire
• Child Symptom Checklist
• SCARED – Child Version
• SCARED – Parent Version
• CES-D – Child Version
• CES-D – Parent Version
• Autism Questionnaire (6-18 Years)
• Adult Personality Questionnaire