Download Forms

Prior to your first visit, please download, print and complete the intake forms required by your therapist or psychiatrist. The Release of Information form is optional but required if you need your treatment practitioner to speak with another doctor or therapist.

Forms for Jan Beauregard, Ph.D.

General Information

Notice of Privacy Policies

Policy and Fee Information

Submitting Bills for Insurance

Release Form

 

 

Forms for Eileen Long-Farias, M.S., LPC

Coming soon.

Forms for Linda McLaine, Ed.D., LCSW

Agreement for Confidentiality of Individual Treatment

Couple’s Informed Consent Form

Individual Informed Consent Form

Notice of Privacy Policies

Forms for Marija Petrovic, MD

Family Information Release Form

Informed Consent Signature Form

Notice of Privacy Policies

Patient Information Form

Provider Information Release Form

 

Please Note

IPI Clinicians are available by appointment only.

If you are experiencing a crisis and need immediate assistance, please visit your local emergency room or call 911.

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