Psychologist/LIMHP Forms

Patient Information

Patient Demographic Information

• Print and return to office

Patient Checklist

• Print and return to office

Consent to Therapy and Confidentiality Statement

• Print and return to office

Authorization to Release and/or Receive Healthcare Information

• Print and return to office

Electronic Communications Consent

• Print and return to office

Telehealth Consent

• Print and return to the office