New Patient Forms and Information - Locate the form or page you need then click to access it.

• New Patient Self Registration Form - for patients to refer themselves for services
• Professional Referral Form - for medical and mental health professionals to refer patients directly
• Consent for Online/Virtual Mental Health Treatment
• Contact Preferences Disclosure Form
• Controlled Substance Agreement - required for all patients receiving stimulants from our office - email completed form to patient@providersforhealthyliving.com after completion
• Informed Consent for Mental Health Treatment
• Notice of Privacy Practices
• Numbers to Call in Crisis or to Seek Help
• Office Policies
• Patient's Bill of Rights
• Permission for Minors of Divorced/Separated Parents to Obtain Medical Treatment​ - required for all minors whose parents are divorced or separated - email completed form to patient@providersforhealthyliving.com after completion
• Rating Scales for Objective Evidence-Based Treatment
• Release of Information Form - required before records can be sent to or received from another facility or provider - email completed form to patient@providersforhealthyliving.com after completion