Forms

Make it quick! – Filling out these 3 simple forms will make your first therapy session a SNAP!

Please print, complete and bring these forms to your first appointment:

Choose One

• Adult Intake Form
• Parent Authorization, Agreement and Consent for Treatment of Child
• Couples Intake Form

Release of Information Form

Forms for Medication appointments

• Dr. Sesta
• Adult Intake Form

• Dr. Underhill
• Adult Intake Form

• Dr. David Jackson
• Intake Instruction Packet
• Background Questionnaire
• Consent for tx with MP and MD collaboration
• Authorization for Disclosure of PHI to MD
• Authorization for Disclosure of PHI to School

Busy Schedule? Email or Fax your completed forms in advance and we process your insurance and paperwork prior to your first visit!