Patient Forms

Please open the forms below to review or complete them.

• General Forms
• Consent for Treatment
• Release of Information (ROI)
• Credit Card Authorization
• Telehealth Consent
• HIPAA Notice of Privacy Practices
• Medication Refill Policy
• No-Show & Cancellation Policy


• Adult Screening Forms
• ASRS (Adult ADHD Self-Report Scale)
• AUDIT-C (Alcohol Use Disorders Identification Test)
• C-SSRS (Columbia Suicide Severity Rating Scale)
• DAST-10 (Drug Abuse Screening Test)
• GAD-7 (Generalized Anxiety Disorder)
• MDQ (Mood Disorder Questionnaire)
• PC-PTSD-5 (Primary Care PTSD Screen)
• PHQ-9 (Patient Health Questionnaire)


• Adolescent Screening Forms
• PHQ-A (Adolescent Depression Screening)
• SCARED (Anxiety Screening for Children)
• Vanderbilt Parent Initial Assessment
• Vanderbilt Parent Follow-Up Assessment
• Vanderbilt Teacher Initial Assessment
• Vanderbilt Teacher Follow-Up Assessment