Patient Forms

Streamline your care—fill out the right forms before your visit.

At Diversified, we believe that great care begins with clear communication.

To make your experience as smooth and efficient as possible, we offer secure, easy-to-complete forms for new and returning clients. Completing the appropriate form in advance ensures that our team is prepared to meet your needs right from your first appointment.

New Patient Intake Form

If this is your first time visiting us, start here.

This form helps us get to know you and understand how we can best support your health and wellness journey.

General Intake Form

Returning adult clients or those updating their records should use this form.

It includes essential health and treatment history to help us continue your care effectively.

Child & Adolescent Intake Form

For clients under 18, parents or guardians should fill out this specialized form.

It’s designed to gather information relevant to children’s and teens’ mental, emotional, and physical care.

Please read the notices, and sign the contracts so we can get you checked in and seen by a therapist as soon as possible

Notice of Privacy Practices

Tele-Behavioral Health Consent Form

Tele-Behavioral Health Crisis Protocol

Outpatient Services Contract

Outpatient Services (Signature) Contract

Your Privacy Matters

All information submitted through our forms is kept confidential and securely stored in compliance with HIPAA guidelines. If you have questions or are unsure which form to use, feel free to contact us or call our office directly—we’re here to help.