Current/Previous Client Forms
In order to provide the best care possible, we require that parents attend the first appointment. This applies to all clients under the age of 18.
Current/Previous clients please fill out the Registration Packet first:
Additional Documents Requested for first appointment (Staff and/or your clinician will inform you if you need to complete any of the below documents):
Patient Rights for Medicaid/Tricare Consumers
HIPAA Information/Notice of Privacy Practices
Adult Comprehensive Clinical Assessment Form
Child/Adolescent Comprehensive Clinical Assessment Form
Information for New Clients being seen in Office
Information for New Teletherapy Clients
Coordination of Care Exemption Form
Consent of Treatment for a Minor
Medical Release of Information
Medical Release of Information for Client’s with Medicaid Insurance
Informed Consent for Online Therapy Services
Informed Consent for In person Therapy Services
Requesting to not have Medical Records Released
Forms needed to be completed when Information has changed:
- (i.e. Custody paper work, Updated POA, etc.)
The Teacherage offices are Handicapped Accessible with a Handicapped Accessible restroom.
PO BOX 9909 Fayetteville, NC 28311