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 through our form portal by clicking here or download and print by following the instructions below.
Please download, print and fill out the appropriate forms below and bring them to your next appointment.
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.
- 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, please print and sign:
- Electronic Communication Authorization
- Consent for Telepsychology
- If New Patient, also:
- New Client Information *Required*
- New Patient Info (Adult)
- New Patient Info (Child - Parent, please complete)
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If your appointment is at our Parchment Office, print all appropriate:
- New Client Information *Required*
- New Patient Form (Adult)
- 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, print all appropriate:
- New Client Information *Required*
- New Patient Form (Adult)
- New Patient Form (Child - Parent, please complete)
HIPAA Privacy Policy (For your review)
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If you are scheduled to see Erin Fish, APRN-BC, or Kelly Culmore, DNP:
- New Patient Forms
- Medication Visit Form - Please complete before each medication visit
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Authorization Forms
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