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New Client Forms

After you have scheduled your first appointment, please print and complete forms to bring with you. You will also be asked to bring a photo ID and your insurance identification card. 

Thank you!

Forms for adult clients (print and complete both):

Forms for children and adolescents (print and complete both):

Telemental Health Forms

     Information Letter             

Consent Form

Payment Authorization

Policies and Information 

Cancellation Policy:

The courtesy of advance notice is appreciated if you need to cancel and/or reschedule an appointment. Confidential voicemail is available 24 hours a day.

 

Cancellations with fewer than 48 hours notice and missed appointments will be billed to the client at $60.00 each, except in the case of a genuine emergency. Other exceptions may apply.

In Network and Out-of-Network Benefits:

NPS, Inc. has both in and out of network clinicians. Feel free to contact us to determine what insurance plans we accept. Please contact your insurance carrier to familiarize yourself with your health insurance coverage and benefits for in network and out-of-network services.  The responsible party for the client has complete financial responsibility for health care services provided by an out-of-network professional. 

Privacy Policy:

Our Notice of Privacy Practices is available for download below.

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