Redefining Mental Health Care in Northern Indiana
Forms
In order to serve our clients better we encourage you to complete and bring these initial forms prior to your first appointment. Please contact us with any questions, thank you.
Screening Information
Informed Consent
Indiana Notice Form
Recipient Rights
Release of Information Consent
Financial Policy - Insurance
Payment Contract - Insurance
Personal History Form - Adult (18+)
Personal History Form - Children and Adolescents (<18)
310 N. Michigan St., #204 * Plymouth, IN * 46563-1774 * Phone: (574) 936-3031 Fax: (866) 311-5621 * Email: drcadwell@embarqmail.com
