Patient Forms
Note: You will need Adobe Acrobat Reader to view or print the forms listed below. If you do not have this reader, then you can download it for free at adobe.com. After you've downloaded the reader, if necessary, click on the forms you'll need.
We've provided forms below that you'll need to complete before your first appointment. It will take you about 45 minutes to complete these forms. Simply print the forms and complete them by hand.
All Forms
If you're a new patient then these are the only forms you need to download and complete.
If you're a new patient then these are the only forms you need to download and complete
If you're a new patient for counseling then the only forms you need to download and complete
Individual Forms
If it is a child/ adolescent to be seen for the first time then this forms you need to download and complete
If it is an adult to be seen for the first time then this forms you need to download and complete
With this form you give us authorization to receive health information from another facility or provider so we can provide you the best of care
With this form you give us authorization to release your protected health information to another facility or provider.
This is another release of information form. This form is used to release information to family members and friends that may be involved in the care of the patient.
This form outlines general information about ARPCC to include clinic hours, types of appointments, our policy on late or missed appointments, insurance and payments, record keeping and more.
This form captures demographic data about the client (e.g., name, gender, age, etc.) and contact information (e.g., address, phone numbers, emergency contact information, etc.), referral information, etc.
This form describes how medical information about you may be used and disclosed and how you can get access to this information.
This form updates medical and psychiatric issues during follow up appointment of adults
This form updates medical and psychiatric issues during follow up appointment of children and adolescents.
TMS THERAPY CONSENT FORM
Copyright © 2015 AR Psychiatric And Counseling Center. All Rights Reserved
Phone: 229 244 2030
Links
Forms
Email: arpsych@att.net I Phone: 229 244 2030 , 229 387 8878
