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Forms

New Patient Intake Forms

New Patient Intake Forms

15 pages - Fill online

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Release of Information

Typed signature not accepted - Fill online

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New Patient Intake Forms

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Rights & Responsibilities

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Good Faith Estimate Forms

Typed signature not accepted - Fill online


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Good Faith Estimate Forms

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Please fill out the New Patient Intake forms and any Release of Information you might need before your appointment (PCP, Therapist, School).  New Patient Intake forms are due by NOON the day prior to your appointment.  If the forms are not turned in by then your appointment will be CANCELLED.  

Please bring a copy of your drivers license, insurance card and prescription card to your appointment.

You may email the completed forms or copies of cards before your appointment to admin@cheneypsych.com.

Telehealth Consent To Treatment
 

Telehealth Consent to Treatment Form

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Telehealth Consent to Treatment Form

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Controlled Substance Agreement 

Controlled Substance Agreement

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Controlled Substance Agreement

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Individual Provider Release Of Information Forms

Please fill out for the specific provider you are seeing.  If doing form online typed signature is not accepted.  You may also download and print the PDF version.  PDF verison can either be email to the office at admin@cheneypsych.com or dropped off at the office.

Fill Online Release of Information

Consent To Treat A Minor

Consent to Treat Minor

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Consent To Treat A Minor

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Katie Hunsberger Intake Forms ONLY
 

Katie Hunsberger Intake Forms 

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Katie Hunsberger Intake Forms

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Katie Hunsberger Telehealth Consent Form

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Katie Hunsberger Release of Information

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We offer a variety of services including...

Psychiatric Evaluations

Psychotherapy

Medication Management