FORMS (DocuSign version for electronic completion; please retain a copy for your records after completion. Your responses will be automatically sent to the Clinic)
Please keep in mind that some electronic communications, including those via unencrypted email, are not secure. Although it is unlikely, there is a possibility that information you include in an electronic form or email can be intercepted and/or inadvertently read by other parties besides the person for whom it is intended. Please do not submit your information electronically unless you are comfortable with these risks. If you have questions about forms or need assistance, please call our office at 205-348-5000. If you do not wish to complete forms electronically, you may complete them when you arrive for your first appointment. Please arrive at least 15 minutes early for completing paperwork at your first appointment.
DocuSign – UA Informed Consent (all clients or their legal guardian)
DocuSign – Email Consent (all clients or their legal guardian)
DocuSign – Emergency Contact (all clients or their legal guardian)
DocuSign – Release for Student Account Services to be Billed (UA students who wish for charges for Clinic services to go to a student account, rather than paying in person)
DocuSign – Test Approach Agreement (adults/college students scheduled for evaluation/assessment)
DocuSign – Child Psychological Evaluation Agreement (parents of children/adolescents scheduled for evaluation/assessment)
DocuSign – Child Psychological Treatment Contract (parents of children/adolescents scheduled for therapy)
DocuSign – Collateral Agreement (parents of children/adolescents scheduled for therapy)
You may be asked to complete additional forms when needed; please ask your provider before completing them.
DocuSign – Collateral Agreement
DocuSign – Telepsychology Consent
Information from all Clinic forms (PDF versions) is available for your review at anytime using the links below:
Telepsychology Informed Consent (when applicable)
Test Approach Agreement (adult evaluations only)
Child Psychological Evaluation Agreement (child/adolescent evaluations only)
Child Psychological Treatment Contract (child/adolescent therapy only)
Release for Student Account Services to be Billed (UA students only, when applicable)