Forms

Welcome to the Forms Library

All of the forms on this page are the same forms that I use in my practice, so if you are looking for a way to hit the ground running this is a great place to start. Downloads are available immediately as Microsoft Word files (unless otherwise specified) so you can customize the form to suit the needs of your practice and begin using them within minutes. Forms are grouped into the following categories: Client Paperwork, Clinical Forms, General Office Forms, Insurance Related, and Marketing. There are also two bundles: The Private Practice Starter Pack (contains seven essential files including: Progress Note, Client Contact Sheet, Release Form, HIPAA Notice, Payment Agreement, Initial Assessment & Credit Card Authorization Form) and The Complete Practice Library which includes all of the forms in the library at discounted pricing.

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Client Paperwork


Used for clients experiencing financial hardship who cannot pay your full fee. Designed to make the decision making process more objective by allowing the clinician to consider what is reasonable given the client's resources without the stress of deciding in session when the issue is raised by the client. This…

Collect client information including demographics, contact information, referral source and communication preferences.

Standard release form for adults or children. Can be used both to release and/or obtain information from third parties.

If your client should fall behind on paying their balance, this form serves as a payment agreement to bring their account current. It authorizes you to charge a credit/debit card on mutually agreed terms and conditions.

Specifies amount and terms of payment for psychological testing. Captures credit card information prior to onset of testing to ensure that you will be paid for your time. Using this form could literally save you hundreds of dollars.

This is a required form that all clients must receive. 

A must when working with children of separated or divorced parents. Clearly documents that you are taking appropriate steps to involve and obtain consent of the non-presenting parent. Doing so isn't just required, but will save you a lot of grief down the road.

Part of the initial paperwork clients complete at the first visit. Specifies your full fee rates, policy for in-network and out of network insurance and consequences of not paying balance due on account.

Contains seven essential files including: Progress Note, Client Contact Sheet, Release Form, HIPAA Notice, Payment Agreement, Initial Assessment & Credit Card Authorization Form

Clinical Forms


Comprehensive initial evaluation for first time clients. Easy to follow semi-structured interview format. Covers all major areas to complete a thorough psychological assessment. 

This is a pre-formatted progress note. The note is a modified DAP note meaning that there are additional check boxes that pertain to the client's status, prognosis and treatment plan, which adds to the efficiency of the note. Form can be easily edited to suit your needs.

This is a seven page pre-surgical psychological assessment for use with those who are considering bariatric (i.e., gastric bypass) surgery.

Use this letter to communicate your impressions and treatment recommendations to your client's primary care physician. In addition to improving collaboration between providers, I have found that this can be a helpful marketing tool as well.

General Office Forms


This is the form we use for the first contact with new clients. It captures relevant contact and insurance information as well as a description of the problem the person is seeking help for. There is also a notes section to keep track of phone calls and other relevant information.

Sent to client with release of records form explaining the nature of the request for records.

If you have other clinicians working for you, this form allows the therapist to document clients seen, length and type of session, diagnosis and more. The encounter form is then given to the billing person who inputs charges to submit for insurance. Specifically designed so that therapists don't have to…

Explains status of appeal with insurance company and implications for client.

Sent to client when outstanding balance on account has been unpaid and bills have not been sent to client due to oversight or office error.

Sent to client with outstanding balance who has not paid on account for specified period of time.

Letter sent to client with balance when insurance payment sent to client rather than provider.

This form allows you to retain a client's credit card information for future payments, including scheduled recurrent payments. Several options are provided to allow the client control over under what circumstances their card can be charged. This is also helpful when seeing a teen or young adult when the parent…

This bundle includes everything in the forms library. Take advantage of discounted bundled pricing to have everything you need for your practice.

This four page document formalizes the business relationship when hiring independent contractors. Easily edit and customize for your practice.

Insurance Related


Sent to insurance company when claim is incorrectly denied for being filed late.

Sent to insurance company to appeal denial of payment on claim(s)

Used to appeal an insurance company denial of payment for a previously submitted claim.

Marketing


Customize this letter to introduce yourself or your practice to local doctors. Letter is based on a "permission based" marketing approach. 

If you provide pre-operative psychological evaluations for bariatric surgery patients (i.e., gastric bypass), use this letter to market to local surgeons.