Client Forms
If you are a new client of Psychology Associates of Grand Rapids we ask that you supply some additional information.
You may submit these forms online up to 48 hours in advance through our form portal by clicking here or download and print by following the instructions below.
These forms are in Adobe PDF format. The free Adobe Reader is available at the Adobe website.
Ways to return completed paperwork:- Via our form portal link above (at least 48 hours in advance)
- Fax to: 616-957-2409 or 616-458-4440
- Email to: (please contact the office or your provider for this email address)
- Snap a picture and fax or email
- Mail to: 1000 Parchment Dr. SE, Grand Rapids, MI 49546 or 555 Mid Towne St. NE Ste 304, Grand Rapids, MI 49503
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If you have a teletherapy appointment, these forms are *REQUIRED*:
- Electronic Communication Authorization
- Consent for Telepsychology
- If New Patient, also:
- New Client Information
- New Patient Info (Adult) OR
- New Patient Info (Child - Parent, please complete)
- New Client Information
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If your appointment is at our Parchment Office, these forms are *REQUIRED*:
- New Client Information
- New Patient Form (Adult) OR
- New Patient Form (Child - Parent, please complete)
HIPAA Privacy Policy (For your review)
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If your appointment is at our Mid Towne Office, these forms are *REQUIRED*:
- New Client Information
- New Patient Form (Adult) OR
- New Patient Form (Child - Parent, please complete)
HIPAA Privacy Policy (For your review)
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If you are scheduled to see Kelly Culmore, DNP:
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Authorization Forms
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