Helpful forms and downloads

STEP 1: Intake Forms

These forms provide personal and financial information necessary to set up a clinical and billing account. You should select and complete the appropriate form, and bring this in to your first appointment.

 

They may be opened in Adobe Reader and printed on your printer. If you have a recent version of Adobe Reader, the forms may be filled out on your computer and printed on your printer. Please be aware that you cannot save your form that is filled out using Adobe Reader (you need Acrobat Standard or Acrobat Professional to save a form completed on your computer. To download a free version of Adobe Reader, click the Adobe link below.

Adult Intake Form

Child and Teen Intake Form

*Couples Intake
Complete when two adults are seeking counseling for relationship issues

STEP 2: *Office Policies, Informed Consent, and Protecting the Privacy of Your Healthcare Record

This is a necessary form to download that contains information about the office and protecting your privacy. You will need to read this form and sign the last page. Bring in the last signature page along with the above intake form to your first appointment.

Other Forms You May Need

Occasionally, you may be instructed to complete additional forms or tests needed in the course of your evaluation and treatment.

General Release of Information

This forms allows your provider to communicate with others involved in your or your child’s care.

*Adult/Child Release of Information
 


Northwest Psychological Resources - 945 11th Ave., Suite B - Longview, WA 98632 - 360-414-8600 - FAX-360-636-7372

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