Forms for Download

Please note there may be additional forms to complete. For assessment forms, please contact the office to request an intake packet be sent to you.

For Child Assessment:

1. Appointment Letter
2. Child History Form – Print, complete, and email to info@hpsych.com or Fax to 517.337.9545
3. Map
4. Privacy Notice
5. Good Faith Estimate Notice

For Adult Assessment:

1. Appointment Letter
2. Adult History Form – Print, complete, and email to info@hpsych.com or Fax to 517.337.9545
3. Map
4. Privacy Notice
5. Good Faith Estimate Notice

For Adult Therapy:

1. Treatment Services Contract – Print, sign, and email to info@hpsych.com or Fax to 517.337.9545
2. Adult History Form – Print, complete, and email to info@hpsych.com or Fax to 517.337.9545
3. Map
4. Privacy Notice
5. Good Faith Estimate Notice

For Referring Agency:

1. Referral Form
2. Release of Information
3. Brochure for Neuropsychological Evaluations (Dr. Jennifer Huffman)