Current Patient Information

​Current Patient Forms - Locate the form you need then click to access it.

• Consent for Online/Virtual Mental Health Treatment
• Contact Preferences Disclosure Form
• Controlled Substance Agreement - required for all patients receiving stimulants from our office - email completed form to patient@providersforhealthyliving.com after completion
• Credit Card Authorization Form - email completed form to patient@providersforhealthyliving.com after completion
• Financial Agreement for Psychological Testing Services
• Informed Consent for Mental Health Treatment
• Medication Refill Request Form
• No Surprises Act (for out-of-network billing)
• Notice of Privacy Practices
• Office Policies
• Numbers to Call in Crisis or to Seek Help
• Paperwork Completion Request Form
• Patient's Bill of Rights
• Permission for Minors of Divorced/Separated Parents to Obtain Medical Treatment​ - required for all minors whose parents are divorced or separated - email completed form to patient@providersforhealthyliving.com after completion
• Rating Scales for Objective Evidence-Based Treatment
• Release of Information Form - required before records can be sent to or received from another facility or provider - email completed form to patient@providersforhealthyliving.com after completion