PATIENT FORMS

Patient Forms

It is helpful if new patients can complete the following forms before their initial visit to NACH. First, please read the Psychologist-Patient Services Agreement and the Health Insurance Portability and Accountability Act (HIPAA) pages. Then, please print and sign the Consent Form indicating you accept our agreement.

Also, please print, complete, and sign the Patient Information form, Financial Policies page, and a Background Information form (complete the Adult form if the patient is an adult, Young Adult form if the patient is a teen, and the Child form is the patient is a child).

If you have any questions or difficulties with these forms, please contact our office.

Psychologist-Patient Services Agreement and HIPAA

Consent Form

Teletherapy Consent Form

Patient Information Form

Psychology Resources Developmental History Form

Young Adult Background Information Form

Form to Release Records

To give us permission to release your records from NACH OR to request your records be sent to NACH from another facility/doctor, please use this form:

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*Saturday testing appointments are available!