Inspire Therapeutic Services, LLC
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    • Home
    • Contact Us
    • About Us
    • Client Log In
    • Assessments
    • Billing
    • Specialties
    • Insurance & rates
    • Forms
    • Adults
    • Individual Therapy
    • Couples Therapy
    • Family Therapy
    • Children & Adolescent
    • HIPAA
Inspire Therapeutic Services, LLC
  • Home
  • Contact Us
  • About Us
  • Client Log In
  • Assessments
  • Billing
  • Specialties
  • Insurance & rates
  • Forms
  • Adults
  • Individual Therapy
  • Couples Therapy
  • Family Therapy
  • Children & Adolescent
  • HIPAA

Client Forms

Outpatient-Service-Agreement-Rev.-01.22 (pdf)Download
HIPAA-Notice-of-Privacy-Practices-Acknowledgment (pdf)Download
Release-of-Information-for-Insurance-Billing (pdf)Download
New-Client-Registration-01.2021 (1) (pdf)Download
New Registration Form (Cont.) (pdf)Download
Authorization for Credit Debit Card Payment (pdf)Download
Parent Authorization for Minor’s Mental Health Treatment (pdf)Download
EAP-New-Registration (pdf)Download
Authorization to Release Information (pdf)Download
GAD-7_Anxiety-updated_0 (pdf)Download
Patient Health Questionnaire PHQ9_id_date_08.03 (pdf)Download

Medical Record Copy Fees

There is a $25.00 fee for Medical Records

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