Intake Forms

Please download and print out the intake form that corresponds to your provider.  Please bring completed contact information and signed consent forms to your first appointment. The remaining pages are for you to keep for your records. Feel free to contact us if you have any questions about filling out the forms.

Dr. Eric Morse: click here to download (.pdf) 

Dr. Michelle Joshua: click here to download Information and Consent to READ (.pdf)

Dr. Michelle Joshua: click here to download Notice of Privacy Practices to READ (.pdf)

Dr. Michelle Joshua: click here to download Intake Form to COMPLETE (.pdf)

Dr. Heidi Green: click here to download (.pdf)

Keisha H. Bryan, LCSW, LCAS: click here to download (.pdf)

Joseph Rabiega, MA, LPC:  click here to download Intake form (.pdf) (Please complete the first 4 pages and bring them to your first appointment along with your insurance card. Please read the last 7 pages carefully- you do not need to download them or bring to your appointment unless you have questions.)

Dr. Joshua Dittmerclick here to download Intake form (.pdf)

Dr. Jun He: click here to download (.doc) 

Dr. Hima Palakurthi: click here to download (.pdf) 

Mark Wells, LCAS, CSOTS, LCSWA :click here to download Clinical Practice Policies.docxclick here to download Adult New Patient Form.doc; click here to download Child New Patient Form.doc