We receive many referrals for services from Employers, Schools, Primary Care Physicians, Department of Health & Human Services Workers, Court Officials, and so forth. Please download, fill out, and fax or email back to us the appropriate form. We guarantee to call the potential client and/or referral source within 24 business hours to set an appointment up. Please keep in mind we have morning, night, and weekend appointment available and we accept most insurances including but not limited to all of your medicaids and medicare. 

Referral forms

These three forms below are intended to be used by community agencies, doctors offices, and schools, on behalf of a perspective client, for services. If you are looking for services for yourself or your child, you do not need to submit a referral form. Please just give us a call or write to us under the "CONTACT US" tab. 

General School Referral Form (pdf)

Download

Physician Referral Form (pdf)

Download

Organization Referral Form (pdf)

Download

Other Consents & Release

These forms are our consent and release forms, typically done upon arrival of the first appointment. They may be completed ahead of time if you want to get a jump start on signing these forms. The front desk will always be available to answer questions. 

MHAC Consents & Releases (pdf)

Download

NOTICE OF PRIVACY PRACTICES - Just for Review. You don't have to print this. (pdf)

Download

Welcome Packets

These forms are intended to be used and filled out by the potential client and/or their guardian if it is a child. EVERYONE needs to print off one of the packets below and bring it in for your first session. Parents of school based children are encouraged to print off a Child Welcome packet and return it to our office. The welcome packet may have already been sent to you via your patient portal for non-school based children and adults coming into the office. 

Child Welcome Packet & Medical History (pdf)

Download

Adult Welcome Packet & Medical History (pdf)

Download