Forms

Intake forms

All forms are currently being reformatted to meet the University's accessibility standards. Please contact the Psychological Services Center to receive copies of these forms while these edits are being made.

Please print all forms and bring the completed documents to your first appointment.

Intake information
Service policies
Notice of Privacy Practice
Consent for Psychological Service
Financial Agreement

Patient Information forms

Client Satisfaction Survey
Request for access to records
Complaint regarding health information
Restrict use or disclosure request
Amendment request
Alternative means of communications
Accounting disclosure

Department Contact Information

Location: Effie Mona Mack

Mailstop: 0296

Mailing Address: 1664 N. Virginia Street, Reno, NV 89557-0296

Phone: (775) 784-6828

Fax: (775) 784-1126