Policies and Forms

Patient Policies and

Important Forms

To make your experience as smooth and efficient as possible, please find the form(s) relevant to your needs, complete them, and bring them to your appointment. Having these forms ready in advance allows us to serve you better and make the most of your time with us. If you have any questions or need assistance, don’t hesitate to reach out to your designated office—we’re here to help!

Questions? Message ACTS Here
Adults / Seniors
Adult Intake Form
Child / Adolescent / Testing
Child & Adolescent Intake Form
Psychological Testing Form
Psychological Testing Agreement
Teletherapy
Teletherapy Informed Consent
Financial Policy Form
Fee Agreement & Cancellation Policy
HIPPA Consent Form
Acknowledgment of Privacy Practices
Neurofeedback
Neurofeedback Fee Schedule
Payment Plan
Payment Agreement Form
Release of Healthcare Form
Authorization to Release

ACTS:

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At ACTS, we are here to support you every step of the way. Whether you're seeking therapy services or need specialized testing, our compassionate team is dedicated to helping you navigate life's challenges with care and expertise. Let us be your partner in achieving growth and well-being.

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