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.
Forms for Hope Springs Behavioral Consultants
- HIPAA Privacy Notice (PDF)
- Safety Protocol COVID-19 (PDF)
- Health-Screening Questionnaire
- Informed Consent for Returning to In-Person Services
- Informed Consent for Returning to In-Person Services (PDF)
- Informed Consent for Telepsychology
- Informed Consent for Telepsychology (PDF)
- Outpatient Services Contract
- Outpatient Services Contract (PDF)
- Child Intake
- Adult Intake
- Release of Information
Other Forms
- Teacher Questionnaire
- Parent Questionnaire
- Parent 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
- Center for Epidemiologic Studies Depression Scale (CES-D), NIMH
Adult Intake Form for Dr. Carroll Collins’ Patients Only (PDF)
