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.
Printable Forms
For medication management appointment with Dr. Bartz:
Online Forms
Provider Referral Form
For a psychotherapy or neuropsychological assessment appointment:
Printable Forms
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Registration Packet–Child
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Registration Packet–Teen
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Registration Packet–Adult
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Release and Exchange of Information (for your physician, school, and any other providers)
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Teacher Rating Scales (ask 1-2 teachers who know your child well to complete these scales)
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.
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Registration Packet–Teen
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Registration Packet–Adult
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Release and Exchange of Information (for your physician, school, and any other providers)
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Teacher Rating Scales (ask 1-2 teachers who know your child well to complete these scales)
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
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Registration Packet- Child
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Registration Packet- Teen
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Registration Packet- Adult
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Release and Exchange of Information- Physician
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Release and Exchange of Information- Other provider, school, therapist