Psychologist/LIMHP Forms

Patient Information

Patient Demographic Information

• Print and return to office
• Sign electronically

Patient Checklist

• Print and return to office
• Sign electronically

Consent to Therapy and Confidentiality Statement

• Print and return to office
• Sign electronically

Registration Information

• Print and return to office
• Sign electronically

Authorization to Release and/or Receive Healthcare Information

• Print and return to office
• Sign electronically