Client Forms
All Patients
Please use the UPLOAD link below to send us a copy of your insurance card (front and back) and a photo ID. You will be asked to update the Patient Registration Packet on an annual basis.
New Adult Patients for Psychiatry
Please review and complete forms 1-9. Answer the questions and push submit when complete. Your documents will be sent to us directly and securely.*
New Adult Patients for Therapy only:If you are scheduled to see one of our therapists, please fill out forms 1-8 and 15 -16.
New Adolescent Patients for Dr. Smith
Please complete forms 1-10. The Child Behavior Checklist (form 10) will need to be printed and filled out by a parent or guardian. Once completed, you may fax it to 907.222.0754 or if you scan the document, you may use the UPLOAD link below to send it securely.
In-Person Appointments
Please give us a call if you are sick, to either switch to telemedicine/teletherapy or reschedule if appropriate. (Please visit our COVID-19 page to see more details.)
Mood Tracking Form
The Mood tracking chart is available to download and print should you and your provider find this a helpful tool.
If you have any questions or need assistance, please feel free to call us at 907.222.0753. Our staff is happy to help.
* Form 11 is a HIPAA Privacy Notice for your review only and is available to print.
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Forms 1-9, and 15-16 are Electronic Submissions. For all other forms, use the PDF button to to the right or click on the form, download, fill out, and send to our office either by email/fax/ or upload using our secure UPLOAD Link below.