Patient Forms

Forms & Documents

Download your new-patient packet below and complete it before your appointment — or ask us to send it when you schedule. Either way, your first visit starts smoothly.

Before Your First Appointment

What to Do:

  • Complete all required forms before your appointment
  • Bring your completed forms with you
  • Arrive 15 minutes early for your first visit
  • Bring a valid photo ID

Submission Options:

  • Download and print your packet below
  • Complete forms during your visit (arrive early)

New Patient Packets

One packet has everything you need for your first visit — download it, print it, and take your time filling it out at home.

Adult New Patient Packet

Required
30-45 minutes

Everything an adult patient completes before the first visit, in one document: practice information, intake and medical history, payment & insurance information, and consent for treatment.

Download Adult New Patient Packet (PDF · 30 pages)

Prefer paper? We'll send or provide it when you schedule — call (859) 341-7453.

Child & Adolescent New Patient Packet

Required
45-60 minutes

The complete packet for patients under 18: parent and child intake, developmental and school history, payment & insurance information, and consent — everything needed for the three-part child evaluation.

Download Child & Adolescent New Patient Packet (PDF · 44 pages)

Prefer paper? We'll send or provide it when you schedule — call (859) 341-7453.

Mental Health Assessments

These screening tools help us better understand your symptoms and provide more targeted care. Complete only the assessments that apply to your concerns.

Depression
3-5 minutes

Depression Screening (PHQ-9)

Nine-question assessment to screen for depression symptoms.

Take the online version on our screening page — or we'll provide it at your visit.

Anxiety
3-5 minutes

Anxiety Screening (GAD-7)

Seven-question assessment for generalized anxiety disorder.

Take the online version on our screening page — or we'll provide it at your visit.

ADHD
10-15 minutes

ADHD Self-Report Scale

Comprehensive assessment for adult ADHD symptoms.

Download PDF
Mood
5-10 minutes

Mood Disorder Questionnaire

Screening tool for bipolar disorder and mood episodes.

Take the online version on our screening page — or we'll provide it at your visit.

Trauma
5-10 minutes

PTSD Checklist (PCL-5)

Assessment for post-traumatic stress disorder symptoms.

Take the online version on our screening page — or we'll provide it at your visit.

Specialty Forms

Child/Adolescent Intake

Specialized intake form for patients under 18 years old.

Note: Parent/guardian signature required

Provided when you schedule — call (859) 341-7453.

Couples Therapy Assessment

Relationship history and goals for couples counseling.

Note: Both partners must complete

Provided when you schedule — call (859) 341-7453.

Medication Management Form

Current medications, side effects, and treatment response.

Note: Bring current medication bottles

Provided when you schedule — call (859) 341-7453.

Crisis Safety Plan

Personalized plan for managing mental health crises.

Note: Completed during appointment

Provided when you schedule — call (859) 341-7453.

Need Help with Forms?

If you have questions about completing any forms or need assistance, our staff is here to help. Don't let paperwork prevent you from getting care.

Call (859) 341-7453

If you're experiencing a psychiatric emergency, call 911 or go to your nearest emergency room.