Media One Sheet for Alan Thomalla

This page provides links to required forms and useful information. Simply click on the title of the resource you want and you will be either redirected to another page or provided an opportunity to download the item.

Registration Forms

Prior to coming to your intake appointment it is important to complete the forms below needed to register for services. These include our Registration Form, HIPAA Agreement, Financial Authority, and our Consent to Treatment forms. Depending on who is to receive services, please also bring either the Adult, Child, or Teen Background form along with the Parent Child Evaluation as appropriate. You may also want a Release of Information to share information with your doctor, school, court, etc.

If these forms are not completed prior to arriving for your first appointment, your time will need to be used completing forms rather than consulting with the psychologist. On the other hand, valid registration is important so if you have questions, please do not hesitate to ask. Please select the forms needed below to download and fill-out. It is appreciated if you write legibly and be sure to complete all sections. Then bring the forms with you to your first appointment.

Registration Form Adult Background Release of Information
HIPAA Agreement Child Background Child Testing Summary
Financial Authority Teen Background
Consent to Treatment Parent Child Evaluation


Send Us a Message

%d bloggers like this: