Forms for New Clients

We use a HIPAA-compliant vendor to securely deliver client forms submitted through our website.

FORMS NEEDED BEFORE YOUR FIRST APPOINTMENT

Please click on the buttons below to fill out and submit forms on-line.

Client Contact Info & Consent Form

 

Client Demographics & History

 

Please read the following policies, and then click the button to sign the acknowledgement form:

Joint Notice of Privacy Practices

Consumer Rights & Responsibilities

Consumer Grievance Process

Appointment Policy & Agreement

Acknowledgement of Policies

 

Client Financial Policies

 

Consent for Telehealth Form

 

Consent for Electronic Communication Form

 

For Child & Family clients only:

Consent for Data Collection – Child & Family Team

 

If you do not have insurance, you may have the option for services provided by an intern at no cost. If you are interested in that option, please complete this form:

Consent for Services by a Student Intern

 

ADDITIONAL FORMS 

If you need to submit a Release of Information form, you can do so here:

Release of Information Form

 

The following forms can not be submitted on-line. They are provided for reference as you discuss them with your provider:

Client Status Review Form

Alaska Screening Tool

 

DOWNLOAD & PRINT OPTION

If you prefer and if you have access to a printer, you may download, print, complete and scan the entire intake packet and use the button below to upload the forms to us.

Child & Family Intake Packet

Adult Intake Packet

 

UPLOAD FORMS

You can use this button to upload any documents to us, including intake packets, insurance forms, and other items staff may request.  Click the button, fill out the information requested, and then click the button labeled “Click to Upload”. This will let you browse your computer/device and select a file to send to us.

File Upload Form