Forms & Questionnaires

Please complete only the appropriate paperwork for your concern listed below and upload clear pictures of the front and back of your insurance card(s). Click here for more information on insurance and billing.
If applicable, we require that the following information is sent to us PRIOR to your first visit: IEP/504 Plan, previous psych-related testing & hospitalization discharge summaries. If your documents/pictures are too large to send this way, please email them to us at instead. 
Once we have received ALL NECESSARY documents, our clinical team will review your paperwork and we will be in touch within 2 weeks to let you know the next steps and timeline.

Step One

Please Upload Clear Pictures of the FRONT & BACK of the Client’s Insurance Card(s) and Scanned Copies of Other Important Documents (each document MUST be a single file. PLEASE DO NOT UPLOAD LARGE DOCUMENTS ONE PAGE AT A TIME (e.g., IEP/504 Plan, previous psych testing, hospital discharge summaries, etc.).

Are you currently enrolled in college courses?

College students can find their necessary paperwork below. This set of paperwork applies to both traditional and non-traditional students, regardless of part or full-time status. Complete only this form, if applicable. Students only need to complete this step.

College Student Questionnaire

Step Two

For all consultations, assessments, and other services, please complete these THREE documents.

1. Personal Information/Referral Form

2. Authorization for the Exchange of Information

3. Multiple Consents/HIPAA Form 

Step Three

Please complete the most applicable ONE of the following questionnaires IN ADDITION to the above necessary documents.

PARENT QuestionnaireFor children under the age of 18 or still enrolled in high school.

ADULT Questionnaire: For individuals 18 and over (and not a high school student).

Cuestionario para los Padres: Si es padre (s) de un niño menor de 18 años, complete el cuestionario para padres

Vision & Hearing

Prior to the consultation appointment please have the client’s vision and hearing screened by their medical provider.

Neurological Injuries

If either you or your child has had any neurological injuries that have been treated, please have your medical provider clear you for testing, and provide us with any reports summarizing the injury and treatment.
Click or drag files to this area to upload. You can upload up to 15 files.
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