Forms

Please complete either the Child or Adult Intake Form, before your arrival to your first visit. The Child and Adult Intake Forms will submit directly to Beech Tree upon completion.

You can complete additional forms without printing by choosing “Fill & Sign” in Adobe Reader to add text or signatures, or by choosing “Add Notes” in Microsoft Edge to hand write directly onto the pdf forms. Please email all other completed forms to schedule.beechtree@gmail.com.

If you are a telepsychiatry patient, or would just like us to keep your credit card on file for future use, please complete the Credit Card Authorization Form and return to us at schedule.beechtree@gmail.com.

INTAKE FORMS:

Child Intake Form

Adult Intake Form

Financial Agreement Form

Credit Card Authorization Form

Attendance and Refill Policy

Telepsychiatry Informed Consent Form

Consent to Release Information

Please complete the Release of Information form if you would like us to be allowed to share information with any outside parties.

Release of Information

If you or your child will need to take medication during school hours, please print and fill out this form:

School Medication Form