Here you will find forms that we may need for registration or other reasons.
Please download the files below that are required to be completed for registration. All forms are in PDF format and can be filled out on your computer or your phone (by downloading a free PDF app such as Adobe Fill & Sign or Google Drive).
Once we receive your registration, we will process it and get you connected with a therapist!
Please send all completed registration paperwork to: firstname.lastname@example.org
Required Forms Packet
(Includes: Therapist-Patient Services Agreement, HIPAA Statement, Release of Information for our Supervising Psychologist Dr. Tom Battocletti, Release of Information for your Primary Care Provider, and a Consent for Telehealth Services)
(These are forms that you may need at some point in time)
If you would like to download the forms individually or you need another copy of a form, please click each link below: