New Client Paperwork
You are asked to arrive to your first appointment 15-20 minutes early to complete necessary paperwork prior to your first visit. You also have the option of printing the new client paperwork at home and bringing the completed paperwork to your first appointment.

These questions will guide you through which forms you'll need. Please call our office with any questions you may have.

1. Are you scheduled to see a Psychiatrist for medication or a Therapist for talk therapy?

• I am scheduled to see a Psychiatrist.
• I am scheduled to see a Therapist.

2. Will MPR be billing your insurance for your visits or will you be self pay?

• MPR will be billing my insurance.
• I will be a self pay client.

3. If MPR is billing your insurance, do your benefits for outpatient mental health include a deductible of $500.00 or greater?

• Yes

4. Do you have Medica or United Health Care insurance? If YES, are you an adult or child/adolescent?

• I am an adult (18+) with Medica or United Health Care insurance.
• I am / the Client is a child or adolescent (under 18) with Medica or United Health Care insurance.

Clinic Forms
The following forms are available to download for your convenience.

• Authorization to Release Information
• Permission for Child Therapy
• Notice of Privacy Practices
• Third Party Payor Agreement