Completed new client paperwork is required at the initial session for EACH PRA clinician that you see. Our paperwork serves as consent to treatment and there must be one on file for each clinician at PRA that you are seeing. All the forms needed for your first appointment are listed below under New Patient Paper Work
New Patient Paper Work click to expand/collapse
Please download, print and complete each form – Please do not date the forms, we will date them on the day of your visit.
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Client Information Form11/2018
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Consents and Authorizations Please print and sign both pages - please wait to date until you come in for your appointment. Patients 12 years of age or older must sign both forms. For patients under 18, both parents must give consent for treatment and sign both forms.11/2018
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Credit Card Authorization Form Helpful to have set up with teens or other patients for copays.2014
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Patient Rights/Notice of Privacy Practices This is for you to keep - no need to bring it into your first appointment11/18
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Medical History Form Only print if you are seeing a Psychiatrist/MD5/2017
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Release of Information Form If you would like PRA to communicate with outside agencies, schools, or PCP – you will need one for each separate contact.7/2017
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Exchange of Information Form If you want us to send your diagnosis and treatment plan to your PCP – This is an one time occurrence and does not authorize ongoing communication.2017
For Dr. Donna Woods NEW Patients click to expand/collapse
Please also print any forms from the Additional Forms section, that apply.
For Dr. Christopher Womack NEW Patients click to expand/collapse
Please also print any forms from the Additional Forms section, that apply.
For Dr. Katherine Godfrey NEW Patients click to expand/collapse
Please also print any forms from the Additional Forms section, that apply.
For Dr. Jason Chang NEW Patients click to expand/collapse
Please also print any forms from the Additional Forms section, that apply.
For Dr. Sandy Rhee NEW patients click to expand/collapse
Please also print any forms from the Additional Forms section, that apply.
For Dr. Janeen Paul Yoga Workshops/Classes click to expand/collapse
Please also print any forms from the Additional Forms section, that apply.
For Dr. Barry Lipin Forms click to expand/collapse
Please also print any forms from the Additional Forms section, that apply.
For Dr. Brian Zercher’s Forms click to expand/collapse
Please also print any forms from the Additional Forms section, that apply.
Dr. Erin Conway Neurofeedback Forms click to expand/collapse
Please also print any forms from the Additional Forms section, that apply.
Additional Forms click to expand/collapse
Print any that apply.
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Release of Information Form If you would like PRA to communicate with outside agencies, schools, or PCP – you will need one for each separate contact.7/2017
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Address Change Form
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New Insurance Form We will also need a copy of your new insurance card.
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Charge Card Form If you would like us to keep your charge number on file.
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Within PRA Release of Information To be used when authorizing communication between therapists/MD’s WITHIN PRA.
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Request for copy of own personal Medical Records
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Social Security Omit Policy2017
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Alert Wellness Assessment – Adult (For United Healthcare -UHC/Optum only)
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Alert Wellness Assessment – Youth (For United Healthcare -UHC/Optum only)
For PRA Personnel Only click to expand/collapse
Please also print any forms from the Additional Forms section, that apply.