All of your information will be submitted in a secure environment and in an encrypted format
Click Online next to your provider’s name to fill out and submit your forms electronically. 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 and your child.
Dr. Matthew Crouch, M.D. Online PDF
Dr. Susan Shackelford, Ph.D. Online PDF
Dr. Timothy Cavell, Ph.D. Online PDF
Julie Council, LCSW Online PDF
Kathy Jordan, LCSW Online PDF
Kamie Meeks, LCSW Online PDF
Caroline Sawyer, LCSW Online PDF
Courtney E. Goodrum, LCSW Online PDF
Carol Cordell, LPC Online PDF
Chuck Shields, LPC Online PDF
Sarah C. Gheen, LPC Online PDF
Carrie Ann Reed, LPC Online PDF
Kristy Bailey, LPE Online PDF
Teen Challenge Students Online PDF
Existing patients can save time by clicking the appropriate link below to complete the yearly financial update prior to the next scheduled appointment
The online forms include a statement 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 click through each link and read it prior to completing your forms.
- Informed Consent
- Notice of Privacy Practices
- Financial Statements for Therapy and Testing
- Financial Statements for Medication Management