FORMS (PDF version for printing and signing; return to clinic by mail, fax, or email)

Telepsychology Informed Consent

Release of Information Form

Email Consent 

UA Informed Consent

Collateral Agreement

Child Psychological Treatment Contract

Emergency Contact

Test Approach Agreement

Child Psychological Evaluation Agreement

Release for Student Account Services to be Billed

Good Faith Estimate

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.

DocuSign – Telepsychology Consent

DocuSign – UA Informed Consent

DocuSign – Email Consent

DocuSign – Collateral Agreement

DocuSign – Child Psychological Treatment Contract

DocuSign – Emergency Contact

DocuSign – Test Approach Agreement

DocuSign – Child Psychological Evaluation Agreement

DocuSign – Release for Student Account Services to be Billed