Forms

Please complete the appropriate forms prior to your appointment.  

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

For medication management appointment with Dr. Bartz:

Online Forms

• Medication Management Registration Packet- Child/Teen

• Medication Management Registration Packet- Adult

• Medication Management Release and Exchange of Information

Provider Referral Form

Click Here

For a psychotherapy or neuropsychological assessment appointment:

Online Forms

• Registration Packet- Child

• Registration Packet- Teen

• Registration Packet- Adult

• Release and Exchange of Information- Physician

• Release and Exchange of Information- Other provider, school, therapist

For Telemedicine Appointments

Online Forms

• Telemedicine Consent

For Your BE-Care (Behavioral Express Care) appointment

• Registration Packet

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

• Privacy practices

• Financial policies

• Cancellation policy

• Child confidentiality policy

• Services Contract

• Telemedicine Procedures