Please be aware! Due to confidentiality laws, if you are the parent, relative, or caregiver of a client who is eighteen (18) or older, the client will need to call to schedule/reschedule appointments, and will need to be the person to fill out the below forms. We cannot verify any appointment information (or even confirm an appointment) without a documented release form from the client.
If you are interested in becoming a new client, 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.
Client Forms for Adults
- HIPAA Privacy Notice
- Informed Consent for Returning to In-Person Services
- Informed Consent for Telepsychology
- Outpatient Services Contract
- Adult Intake
- Release of Information (Complete for other providers/people you want us to be able to share information with.)
Client Forms for Children
- HIPAA Privacy Notice
- Informed Consent for Returning to In-Person Services
- Informed Consent for Telepsychology
- Outpatient Services Contract
- Child Intake
- Release of Information (Complete for other providers/people you want us to be able to share information with.)
COVID-19 Forms
- Safety Protocol COVID-19
- Health-Screening Questionnaire
- Informed Consent for Returning to In-Person Services
Amy Carroll-Collins Clients Only
- HIPAA Privacy Notice
- Informed Consent for Returning to In-Person Services
- Informed Consent for Telepsychology
- Outpatient Services Contract
- Adult Intake
Questionnaires
- Teacher Questionnaire
- Parent Questionnaire
- Questionnaire (6 to 18 Year Old)
- Child Symptom Checklist
- Screen for Child Anxiety Related Disorders (SCARED) – Child Version
- Screen for Child Anxiety Related Disorders (SCARED) – Parent Version
- CES-D Child Version
- CES-D Parent Version
PDFs
- HIPAA Privacy Notice
- Safety Protocol COVID-19
- Informed Consent for Returning to In-Person Services
- Informed Consent for Telepsychology
- Outpatient Services Contract
- Community Resources (Inclusion on this list does not imply an endorsement.)
