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.

Quality, Hope, and Personal Responsibility.

​​​CLICK HERE to Complete a NEW PATIENT REGISTRATION FORM Today and Get Help Soon!

HEALTHCARE PROFESSIONALS - You may refer your patients directly using the "Professional Referral Form" link below.  We will contact your patient to schedule an initial intake appointment.  We will contact you directly if we have questions or need additional information.

PATIENTS/PARENTS - If you or a family member are interested in becoming a patient in our practice, simply submit the "New Patient Registration Form" below and you will be contacted to schedule an initial intake appointment.

CHILD ADHD EVALS - If your child/adolescent is coming for an ADHD evaluation, it is helpful to have all parents/guardians and all teachers complete Vanderbilt Diagnostic Forms and bring them to the initial intake appointment. These forms are found on the Rating Scales page linked below.

NON-CUSTODIAL OR DIVORCED PARENTS - If you have split custody or need permission from another parent to provide treatment to your child, please have them complete the "Permission to Obtain Medical Treatment Form" below prior to your initial appointment.  Without this form, your child legally cannot be seen by our providers.

EMOTIONAL SUPPORT ANIMALS - It is our policy NOT to provide documentation for emotional support animals.  Writing an ESA letter involves assessing whether an ESA would meaningfully help a patient.  Our mental health providers are not trained to make this determination.  Since we are not trained to assess disability, we cannot certify a client’s claim for disability benefits.  Given this lack of training, writing ESA letters is arguably outside of our scope of practice.

New Patient Forms and Information - Locate the form or page you need then click to access it.
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• New Patient Self Registration Form - for patients to refer themselves for services
• Professional Referral Form - for medical and mental health professionals to refer patients directly
• 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
• Informed Consent for Mental Health Treatment
• Medical Marijuana Policy
• Notice of Privacy Practices
• Numbers to Call in Crisis or to Seek Help
• Office Policies
• 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

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