Forms

Please complete the appropriate forms prior to your appointment.  Forms can be either printed, completed and brought to the intake appointment or emailed to us at info@pcsmn.com.

Be sure to bring your health insurance card to the appointment.

Please complete forms and bring to your intake appointment

Printable Forms

For medication management appointment with Dr. Bartz:

Online Forms

Provider Referral Form

For a psychotherapy or neuropsychological assessment appointment:

Printable Forms

Fillable Forms

To complete, after clicking on the appropriate link below, click the Download button and choose “Open with Adobe Acrobat” and save to your desktop before sending.

For Telemedicine Appointments

Printable Forms

Online Forms

For Your BE-Care (Behavioral Express Care) appointment

The following forms are for your review (No need to bring to the appointment)

Online Forms