Forms

Emotional Support Animal - Verification Form

After initiating the request for a Emotional Support Animal prescription with your provider please have a verification form completed by your pet’s vet.

Release of Information from Changing Minds Psychiatry

This form is for patient’s that want to their medical records released from Changing Minds Psychiatry either verbally or written.

Release of Information to Changing Minds Psychiatry

This form is for patient’s that want their medical records sent to Changing Minds Psychiatry either verbally or written.

Form Completion Fee Letter

This document is for patient’s that are requesting forms to be completed. This document must be completed to initiate a form request.

Papeleo Para Pacientes Nuevos | New Patient Paperwork

Formularios de pacientes | New Patient Paperwork

Consentimiento del paciente para la fotografía de cuadros médicos | Consent to photo

Consentimiento para discutir la informacion del paciente | General Consent to Discuss

Pin de acceso a la historia clinica del | Chart Access Pin Form

The Vanderbilt Assessment Scales are a set of tools used by health care professionals to help diagnose and monitor ADHD symptoms in children. The scales include a parent version and a teacher version, and both are intended to be completed.

Grievance Form

At our clinic, your well-being is our top priority. We are committed to providing the highest quality of care and ensuring that your experience with us is positive. If at any point you feel your rights have been violated or you are unsatisfied with the care you’ve received, you have the right to file a grievance. We take all concerns seriously and are dedicated to addressing them promptly and respectfully. Your voice matters, and we are here to listen.