Forms

All forms can be filled out online by clicking the title of each link below.

English

New Patient Packet – Adult & Minor
Patient Rights
Release of Information (ROI)
Revocation of Release of Information (ROI) Form
Consent to Treat – Adult & Minor
Informed Consent – Adult
Medicare Questionnaire
Medicare Lifetime Signature Form
Caregiver Affidavit
Informed Consent for Telehealth Services – Adult
Informed Consent for Telehealth Services – Minor
HomePsych Online Appointment Forms

Español

Paquete de Paciente Nuevo – Adulto & Niño
Derechos del Paciente
Consentimiento para la Divulgación de Información (ROI)
Revocation of Release of Information (ROI) Form – Spanish
Consentimiento Para El Tratamiento de Un Menor
Consentimiento Informado Para Servicios De Telesalud
Medicare Questionnaire – Spanish
Medicare Lifetime Signature Form – Spanish
Caregiver Affidavit – Spanish

If you are having an emergency, please call 911.

If this is your first appointment with us, fill out the forms to get started.