Helpful Information, Forms, and Support Resources

Resources

We’ve gathered commonly requested documents, patient resources, and helpful information in one convenient location.

If you cannot find what you are looking for, please contact our team and we will be happy to assist you.

Patient FOrms

New Patient Packet

For new patients preparing for their first appointment.

Review of Systems

A health history form used to help your doctor understand symptoms that may be relevant to your care.

Medical Records Release

Use this form to authorize the release or receipt of protected health information.

Credit Card Authorization Form

Use this form to authorize payment by credit card.

Self-Pay Acknowledgement Form

For patients choosing to pay directly for services.

Practice Policies and Notices

Office Policies and Procedures

Important information about appointments, cancellations, telehealth, prescriptions, confidentiality, and practice policies.

HIPAA Notice

Information about privacy practices and how protected health information may be used or disclosed.

Notice to Psychotherapy Patients

Required notice for psychotherapy patients receiving care from a Licensed Marriage and Family Therapist.

Heid Health Consent Form

Consent information regarding the use of Heidi to assist with clinical documentation.

Patient FOrms

TMS Patient Consent

Consent form for NeuroStar TMS Therapy.

TMS Patient Guide

Patient Guide For Treating Depression

Depression Screening for TMS

Standardized questionnaire for screening and measuring depression severity

Treat to Complete Patient Brochure

36 Treatment Sessions To Completion

What to Expect Day 1 Brochure

What To Expect On Your First Day Of Treatment

Crisis & Emergency Resources

If you are experiencing a mental health emergency, call 911 or go to your nearest emergency room.

988 Suicide & Crisis Lifeline

Call or text 988 for immediate support.

Crisis Text Line

Text HOME to 741741 to connect with a trained crisis counselor.

Emergency Services

If you or someone else is in immediate danger, call 911.

Community Resources

Mental Health Organizations

Trusted organizations providing education, advocacy, and support.

Insurance support is part of making care accessible

Insurance and Courtesy Billing

We know cost and insurance questions can be stressful. Our team will help make the financial side of care as clear as possible and help you understand what information is needed before treatment begins.

Adelpha accepts many commercial insurance plans and also offers courtesy billing for out-of-network patients. For patients using out-of-network PPO benefits, our courtesy billing service can help reduce the burden of submitting superbills independently.

If you are unsure where to begin, reaching out is a reasonable first step.

Adelpha provides thoughtful, comprehensive psychiatric care for patients and families who want clear guidance, qualified support, and care that sees the whole person.

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