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Blue Mountains
Blue Mountains

Helpful Forms

Please print and fill out the Intake form and Office Policies form before your first session.
  • Intake Form
    • This is our standard intake form.  All inforamation will remain confidential, and is part of the information gathering process. Please do your best to answer each question honestly, as this will help us determine how we can help you.
  • Office Policies
    • These are our standard office policies and include the consent for treatment, fee policies and cancellation requirements.
  • HIPPA
    • We are legally obligated to provide you with a copy of the Patient Privacy policies
  • Authorization to Exchange Information
    • You may fill this out if you would like us to speak with any of your physicians, psychiatrists, or other professionals involved with your treatment.
  • Consent to Treat Minors
    • This will be filled out by anyone bringing a minor into therapy

  PPA Intake Form
  PPA Office Policies

 HIPPA Form

 Authorization To Exchange Information

 Consent to Treat Minors
     
     

Note: To download Adobe Acrobat Reader for free, click here.

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Helpful Forms

Click here to view and print forms for your appointment.

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