. . .
  • Worldwide
  • (844) 341-8612 or Text (281) 397-3916
  • Worldwide
  • (844) 341-8612 or Text (281) 397-3916

Forms and Resources

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  • Forms and Resources

If you need a referral to a LPC, LCDC, psychologist, or psychiatrist, contact us and provide us with your zip code. Forms may be emailed to [email protected] or faxed to 844.631.1841.
Crisis plan

HIPAA release of information form

Patient Complaint Form

Cross-cutting symptom measure-child age 6-17

Cross-cutting symptom measure-adult 18 and over

Patient questionnaire

Applicant request form for assistance

Note: We do not evaluate children under the age of 6 years old.

 

*Send completed forms to [email protected] We have found that the easiest way of completing these forms electronically is by downloading the Adobe Fill & Sign app.*

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