The Psychological Center

Screen Evaluation Form - Word Doc (Back-up if Titanium is inaccessible)

Intake Evaluation Form - Word Doc (For all treatment options; to be uploaded into Titanium)

Abbreviated Evaluation Form: PDF - Word Doc

Billing Record

Consent for Telepsychological Services

Consent to Release/Obtain

Consent to Release/Obtain (Spanish)

Disposition/Oral Presentation Format

Fee Agreement

Incident Report

Intake Fee Agreement

Intake Fee Agreement (Spanish)

Outline for 6-Month Summary: PDF - Word Doc

Outline for Termination Summary: PDF - Word Doc

Parental and Caregiver Attestation Form for Unaccompanied Minors - PDF

Permission for Audio/Video 

Permission for Audio/Video (Spanish)

Progress Notes/Encounter Notes: PDF - Word Doc

Progress Notes/SOAP Notes: PDF - Word Doc

Psychotherapy Chart Checklist

Safety Plan

Service Bill for Patient

Service Bill Paid Receipt

Sliding Scale Fee Application

Sole Custody Letter

Therapist Recording Agreement Form

Testing Chart Checklist

Treatment Agreement

Treatment Agreement–Child: PDF - Word Doc