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Encompass Care

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  • Medication Management
    • REBECCA OLANDER, PMHNP-BC
    • SHAYLA HINRICHSEN, PMHNP-BC
    • MICHAEL PURCELL, PMHNP-BC
    • PAIGE BURESH, DNP, PMHNP-BC
  • Psychologists & Therapists
    • AMANDA SCHNEE, PHD
    • CARRIE SEMKE, PHD
    • ERYN MCMASTER, PHD
    • ALEXANDRIA “ALEX” REZNICEK, LIMHP
  • Telehealth
  • Forms
  • About Us
  • Contact Us

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

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  • Sign electronically

Authorization to Release and/or Receive Healthcare Information

  • Print and return to office
  • Sign electronically

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