Patient Forms
All paperwork is to be completed 48 hours prior to your scheduled appointment
Your
information will be sent directly to the office of Southpark Psychology and the Provider will be given your paperwork at the time of your appointment.
Please note all of our Providers are in private practice. They do not share any paperwork.
If you are seeing a different or "New" Provider all paperwork must be completed for that Provider
Adult Therapy- complete if you are seeing a therapist
If you are a returning adult patient who is seeing the same provider as previous and have not been seen for 6-9 months please complete the below paperwork. If you are over 9 months please complete the New adult therapy paperwork
Child / Adolescent
If you are a returning child/ adolescent patient who is seeing the same provider as previous and have not been seen for 6-9 months please complete the below paperwork. If you are over 9 months please complete the New adult therapy paperwork
Nurse Practitioner/Medication Management
Kate Stamer ARNP and Christina Nordick APRN require different forms
Nurse Practitioners- Medical information
Your New patient paperwork will be sent via email to the email you gave us at time of scheduling
All forms must be completed 48 hours prior to your appointment
Nurse Practitioners- Billing information
For all Medication management appointments you must complete the one page billing form and upload your photo Id and insurance cards.
For any patient under the age of 18 the below form is to be used instead of the adult initial intake form
PLEASE ARRIVE AT LEAST 15 MINUTES BEFORE YOUR APPOINTMENT
Miscellaneous forms
If you use these forms they must be printed signed and returned via mail, fax or email. Our contact information is below
Disclaimer:
Information contained in this site or linked sites is intended to be educational in nature and a tool for further exploration. It is not meant to be a substitute for psychological, legal or other professional advice.