If you are a new client, we require that you fill out paperwork before your first appointment. The administrative staff will send the paperwork to you through TherapyPortal, but you can also print it out and fill it out if you prefer. Please select the appropriate paperwork below and complete it. You can use the fillable form, complete it on your computer, then print or you can select the printable version and complete it by hand.
- Adolescent and Child Intake Packet (3 to 17 years old) - Fillable
- Adolescent and Child Intake Packet (3 to 17 years old) - Printable
- Adult Intake Packet - Fillable
- Adult Intake Packet - Printable
- Psychiatric Medical History - Fillable
- Psychiatric Medical History - Printable
- Court Ordered Evaluation - Fillable
- Court Ordered Evaluation - Printable
Note: To download Adobe Acrobat Reader for free, click here.
If you would like us to coordinate care with another provider (for instance, your psychiatrist, insurance company, family, school personnel, Primary Care Physician, etc.), complete this form to authorize release of psychotherapy information. If you chose not to release information to anyone at this time, please check the Decline to Release Information box and sign in the Client Signature area below:
Are you a healthcare professional, probation officer, judge, or therapist who would like to refer a client or patient to our office for mental health services?
Please fill out the referral form below. You can fax it to (801) 302-7248 or email it to [email protected].