Patient Forms

It is helpful if new patients can complete the following forms before their initial visit to Psychology Resources. A digital copy of these forms will be available for review and your signature through your patient portal after your first appointment is scheduled. If you would prefer to fill out the documents on paper, or if you have been asked to fill out a particular form, please review the instructions below.

First, please read the Psychologist-Patient Services Agreement and the Health Insurance Portability and Accountability Act (HIPAA) pages. Then, please print and sign the Consent Form indicating you accept our agreement. Also, please print, complete, and sign the Patient Information form, Financial Policies page, and a Background Information form (complete the Adult form if the patient is an adult, Young Adult form if the patient is a teen, and the Developmental History form is the patient is a child).

If you have any questions or difficulties with these forms, please contact our office.

• Psychologist-Patient Services Agreement and HIPAA
• Consent Form
• Financial Policies

To give Psychology Resources permission to release your records from our practice OR to request your records be sent to Psychology Resources from another facility/doctor, please fill out the Form to Release Records or Information (ROI). This form also applies for parents or spouses that must be granted permission to discuss financial, scheduling, or other matters on behalf of a patient that is over the age of 18 years old.

• Form to Release Records or Information

Under the No Surprises Act, you have the right to receive a “Good Faith Estimate” outlining the expected costs of your medical and psychological care. For more information or to view our standard notice regarding the No Surprises Act, follow the link below:

• Standard Notice: Right to a Good Faith Estimate