Adults (18+)
Please fill out all forms below:

• Terms of Billing
• No Show & Cancellation Policy
• Clinical Intake Form
• Insurance Card Form
• Driver’s License Form
• Major Depression (PHQ-9) Scale
• Cage-Aid Substance Use Screening
• Generalized Anxiety Disorder 7-Item Scale
• Patient Bill of Rights
• HIPAA

Children (Under 18)
Please fill out all forms below:

• Terms of Billing
• No Show & Cancellation Policy
• Clinical Intake Form
• Insurance Card Form
• Driver’s License Form
• Major Depression (PHQ-9) Scale
• Cage-Aid Substance Use Screening
• Generalized Anxiety Disorder 7-Item Scale
• Patient Bill of Rights
• HIPAA

cookAdminINTAKE FORMS09.24.2014