NEW PATIENT PAPERWORK (ADULT)

 

 

Please complete these forms at least 48 hours before your appointment or your appointment will be cancelled.

Registration:   https://fs10.formsite.com/ZPqWEh/lwbmwwwpvx/index.html

Questionnaire: https://fs10.formsite.com/ZPqWEh/ukpjouz7ay/index.html

Credit Card Authorization: https://fs10.formsite.com/ZPqWEh/w30yuc34gh/index.html 

  • If you have an HMO insurance plan that requires a referral, please be sure to contact your primary care physician to generate that referral. 

 

Please feel free to email or call with any questions.

 

Thank you,  

The Staff at Longwood Psychological Center 

(256) 534-8161 

PDF FORMAT

If you would prefer to print off the paperwork and fax it or bring it to the office, please download the PDF below.