Forms and other resources
Clinic Forms
Intake packet (For child patients)
This paperwork is only for patients who have been referred to the clinic prior to October 1, 2024. If you have not been referred, please click here for information about our self pay option.
Intake Packet (for Adult patients)
This paperwork is for patients who have been referred to the clinic prior to October 1, 2024. If we do not have a referral from before that date, please click here for information about our self pay option.
Release of informatioN
Please complete this form if you would like us to send/receive information from another office or provider
Other Referral Options:
North MS providers who accept Medicaid plans for testing services:
Behavior, Attention, and Developmental Disabilities Consultants
North MS providers who do not accept Medicaid but are in-network with private insurance plans:
Campbell Psychological Services
University-based testing services at lower self-pay rates:
“The good life is a process, not a state of being. It is a direction, not a destination.”