Forms

 

We provide these forms so you can peruse, print, and complete them before your first visit to The Clinic.

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The PDF files may be viewed using Acrobat Reader.  You will need Adobe Reader. If you do not already have it installed on your computer, you may download a free Reader by clicking/tapping here.

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You are welcome to scan your documents and email them prior to your initial consultation at drcarroll@themontgomeryclinic.com.

 

THERAPY SERVICES DOCUMENTS

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Please review and complete the intake forms (ONLY Numbers 1-3) below, as directed by Dr. Carroll, who will review all documentation with you at your first session. Please print and complete other forms only at the direction of Dr. Carroll.

 

 

• 1. New Client Intake Form
   

• 2. Confidentiality Agreement
   

• 3. Therapist/Client Payment Contract
   

• 4. Self-Rated DSM-5 Questionnaire
   

• 5. Patient Health Questionnaire
   

• 6. SCL-90
   

• 7. School Excuse Form
   

• 8. Therapist/Client Payment Contact for Groups, Families, Parenting Coordination, & Custody Evaluations
   

• 9. Authorization to Release Confidential Information Waiver

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