Patient Forms

Intake forms provide important information to your provider. Please click on the appropriate form for your specific intake. The form will open in Adobe Sign for you to fill out, sign, and submit electronically to our administrative department. After filling out and signing and pressing SUBMIT, it will prompt you for your email address. Once you submit your email address, you will receive an email to the email account you provided for you to confirm your email address. Once you confirm, the form will be submitted and you will receive a copy of the paperwork.

Paperwork must be submitted 24 hours prior to your scheduled intake appointment.  If paperwork for Psychiatric Intake appointments is not submitted prior to 24 hours, your appointment will be cancelled and you will need to reschedule.  If you are having issues with opening the forms, please contact us.

Online

Adult Individual Therapy:

(Age 18+)

Child/Adolescent Individual Therapy:

(Ages 2-17)

Note* - Parents/guardians need to sign the consent form. 
Note* - If there is a JOINT CUSTODY situation, both parents need to sign the consent form. Please see the Child Consent form below for additional parent signatures.

Couples Therapy:

Note* - Both partners need to fill out an Adult Therapy Packet

Adult Psychiatric Medication Management:

Child/Adolescent Psychiatric Medication Management:

Additional Online Forms:

River Valley's "Cue to be Well"

River Valley's "Cue to Be Well" is a free monthly newsletter, curated by psychologists and other wellness professionals, containing wellness strategies, healthy recipes, clinic updates, special offers, and the like. We appreciate everyone here in this exclusive circle and would like to give back in any way we can.

Check out the archive to enjoy wellness strategies and recipes right now!

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