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Alysia Dendrinos, LMSW, CAADC

Main Campus

COVID-19 Update: In uncertain times, know you are not alone. Meet with a provider in-person or virtually & find the mental health support you need. Click here to schedule an appointment.

Adult Patient History Form

Adult Registration Form

Animal Assisted Therapy Consent Form

Behavioral Health Screening

Child Patient History Form

Child Registration Form

Consent for Observation/Shadowing

Consent for Videotaping/Audio Recording

Contract for the Prescription of Controlled Substances

Credit Card Authorization

Group Therapy Consent Form

Insurance Waiver Form

Notice of Privacy Practices/Consent Form

Payment Consent Form

Payment Consent Form (No CC) - ALTERNATIVE

Release of Information Form

Somatic Movement Consent Form

Transportation Release Form

Walk/Talk Therapy Consent Form

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