Forms

Intake forms 

Please contact the Psychological Services Center to receive copies of these forms.

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