Associated Psychologists, PLC
                             NEW PATIENT FORMS
TWO different forms are required of new patients in our office.

The first is a
Registration form, including insurance information and consent to
treatment. The second is a
Social-Medical History form that will provide
important background information for your doctor/therapist.  You may complete
both of these at home and bring with you to your first appointment.

If you are unable to download them, please plan to arrive
30 minutes PRIOR to
your scheduled appointment time. Both forms must be completed before your
appointment time or your appointment may be rescheduled.

Finally, please contact your insurance carrier if applicable to inquire about your
Outpatient Mental Health benefits; in many cases, these differ significantly from
medical office copays or deductibles.

Click on the link below to download both forms-select the age of the patient
underneath the name of the doctor/therapist you will be seeing. Please note, Dr.
Manion does NOT require the Social Medical History form to be completed.


Drs. Boardway, DeGroat, Dickson, Maltz, Manion, Neal, Yost;
Lori Mitton and Jennifer Parnell


ADULT        CHILD/ADOL (under 21)


Dr, Lujan

ADULT        CHILD/ADOL (under 21)


Dr. Mazzara

ADULT        CHILD/ADOL (under 21)