Better Mood Clinic Forms

Note:  You will need Adobe Acrobat Reader to view or print the forms listed below.  If you do not have this reader, then you can download it for free at adobe.com.  After you've downloaded the reader, if necessary, click on the forms you'll need.

We've provided forms below that you'll need to complete before your first appointment.  It will take you about 45 minutes to complete these forms.  Simply print the forms and complete them by hand.

Referral Forms and Intake Packets

►  Adult Intake Packet

 

►  Child Intake Packet

Release Forms

►  Educational Release

Authorization request to receive educational records.

►  Psychotherapy Release

Authorization request to release and/or receive protected health information. 

►  Medical Release

Authorization request to release and/or receive protected health information. 

►  Protected Health Information Request

This form is used to request protected health information from a provider.
           
 

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