Patient Forms

Patient Forms

If you are having issues with the online paperwork, please contact our office and we will be happy to assist you.

All of your information will be submitted in a secure environment and in an encrypted format

Click the link next to your provider’s name to fill out and submit your forms electronically. Choose “Adult” or “Kids.” If you prefer, you can download the PDF file to print and bring to the clinic.  Please fill out the form as completely as possible to help us serve you.

Chapman, Angela, M.D.  Adult

Crouch, Matthew, M.D.  Kids

Fields, Lisa, APRN  Adult   Kids

Bailey, Kristy, LPE  Adult   Kids

Cavell, Timothy, Ph.D.  Adult   Kids

Cordell, Carol, LPC  Adult   Kids

Council, Julie, LCSW  Adult   Kids

Gheen, Sarah C., LPC  Adult   Kids

Gilchrist, Breanne, LCSW  Adult   Kids

Goodrum, Courtney E., LCSW  Adult   Kids

Gray, Kelly, LCSW  Adult   Kids

Hussey, Jonna, LCSW  Kids

Jordan, Kathy, LCSW  Adult   Kids

Meeks, Kamie, LCSW  Adult   Kids

Murphy, Meghan, Ph.D.  Adult   Kids

Reed, Carrie Ann, LPC  Adult   Kids

Rosa, Ananda E., LCSW  Adult

Saragusa, Sarah, LPC  Adult   Kids

Sawyer, Caroline, LCSW  Adult   Kids

Shackelford, Susan, Ph.D.  Adult   Kids

Shields, Chuck, LPC  Adult   Kids

Walton, Lee, LPC  Adult   Kids

Wilkirson, Ruth, LCSW  Adult 

Will, Danell, LPC  Adult   Kids

Existing patients can click the appropriate link below to complete the yearly financial update prior to the next scheduled appointment

The online forms include statements agreeing that you have read information about our privacy practices, informed consent, and patient responsibility. That information is located within the online forms as well as in the links listed below.  Please review each of these before filling out your forms.