Forms

For child under the age of 18:

Child History Form
 
Child Rating Scales
 
Consent to Release to Insurance Co.
 

 
Please select the informed consent
form for the therapist you are seeing:
Mary Mikalson, MSSW
 
Mindy Haseleu, Psy.D.
 
Tanya Green, MSW, LCSW
 
Levy O'Brion, MS, LPC
 

For an adult:

Adult History Form   Adult Rating Scales  
Consent to Release to Insurance Co.
 

 
Please select the informed consent
form for the therapist you are seeing:

Mary Mikalson, MSSW
 
Mindy Haseleu, Psy.D.
 
Tanya Green, MSW, LCSW
 
Levy O'Brion, MS, LPC