Providing quality, evidence-based interventions in a caring environment.

We are currently providing TELEHEALTH visits (online/virtual visits).  Most insurance companies (private and Medicaid) cover these therapy, medication, nutrition, and psychological testing visits with the same cost share (copays, deductibles, or coinsurance) as in-person visits.  These online visits are convenient, safe, effective, and easy to navigate.

Current Patient Forms - Locate the form you need then click to access it.

• Body Composition Testing Info Sheet & Waiver - required for all patients seeing our nutritionist who want to have body composition testing - email completed form to patient@providersforhealthyliving.com after completion
• Consent for Online/Virtual Mental Health Treatment
• Contact Preferences Disclosure Form
• Controlled Substance Agreement - required for all patients receiving stimulants from our office - email completed form to patient@providersforhealthyliving.com after completion
• Credit Card Authorization Form - email completed form to patient@providersforhealthyliving.com after completion
• EMDR Informed Consent Form
• Financial Agreement for Psychological Testing Services
  
• Informed Consent for Mental Health Treatment
• Medical Marijuana Policy
• Medication Refill Request Form
• Notice of Privacy Practices
• Office Policies
• Numbers to Call in Crisis or to Seek Help
• Paperwork Completion Request Form
• Patient's Bill of Rights
• Permission for Minors of Divorced/Separated Parents to Obtain Medical Treatment​ - required for all minors whose parents are divorced or separated - email completed form to patient@providersforhealthyliving.com after completion
• Rating Scales for Objective Evidence-Based Treatment
• Release of Information Form - required before records can be sent to or received from another facility or provider - email completed form to patient@providersforhealthyliving.com after completion

​CLICK HERE to Complete a NEW PATIENT REGISTRATION FORM Today and Get Help Soon!
​We are now offering Virtual Visits to all patients.  This means current and new patients can continue to receive the mental health services they need in the safety and convenience of their own homes.

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A post shared by Providers for Healthy Living (@providersforhealthyliving) on Mar 11, 2019 at 11:47am PDT