Our Client Forms & Policies

If you are a new client of Psychology Associates of Grand Rapids, please supply these forms before your first appointment.

How to submit your forms.

We’ve made it easy to submit your paperwork. Please choose your preference from the following options below.

Use Our Online Portal

All the forms you need, all in one place. Please submit your paperwork at least 48 hours before your appointment time.

Email Your Forms

Please contact our office or your provider for this email address information.

Parchment Office

616.957.9112

Mid Towne Office

616.458.4444

Fax Your Forms

Fax your completed paperwork to either of our office locations below.

Parchment Office

616.957.2409

Mid Towne Office

616.458.4440

Mail Your Forms

Print and mail us your completed paperwork.

Parchment Office

1000 Parchment Dr. SE
Grand Rapids, MI 49546

Mid Towne Office

555 Mid Towne St. NE Ste 304
Grand Rapids, MI 49503

Our HIPAA Privacy Policy

Please take the time before your appointment to review our HIPAA privacy policy. This policy is in place to protect your personal information and ensure patient confidentiality.

In-Office Appointment Forms

If you are a new client and have an appointment at any of our office locations, please fill out the paperwork below.

New Patient Information

Please submit this paperwork 48 hours before your appointment time.

Adult History Form

Please submit this paperwork 48 hours before your appointment time.

Child History Form

Please submit this paperwork 48 hours before your appointment time.

Teletherapy Appointment Forms

If you are a new client and have an appointment at any of our office locations, please fill out the paperwork below.

For First Time Patients:

If you’re a new patient to us and this is your first appointment, please fill out the forms below 48 hours before your teletherapy visit.

New Patient Information

Adult History Form

Child History Form

For Both Returning & New Patients:

Whether you’re a new or returning patient, you must fill out these forms before your first teletherapy appointment.

Electronic Communication Authorization Form

Consent for Telepsychology Form

Kelly Culmore, DNP Patient Forms

If you are scheduled to see Kelly Culmore, please fill out the form provided below before your first appointment.

Our Client Forms & Policies

How to submit your forms.

Use Our Online Portal

Email Your Forms

Parchment Office

Mid Towne Office

Fax Your Forms

Parchment Office

Mid Towne Office

Mail Your Forms

Parchment Office

Mid Towne Office

Our HIPAA Privacy Policy

In-Office Appointment Forms

New Patient Information

Adult History Form

Child History Form

Teletherapy Appointment Forms

For First Time Patients:

New Patient Information

Adult History Form

Child History Form

For Both Returning & New Patients:

Electronic Communication Authorization Form

Consent for Telepsychology Form

Kelly Culmore, DNP Patient Forms

Authorization
Forms

Credit Card Authorization Form

Release of Information Form

Get The Help You Deserve. Contact Us.

Want To Join Our Professional Team?

Get In Touch:

Parchment Office:

Mid Towne Office:

Resources:

New Client:

Existing Client:

Our Client Forms & Policies

How to submit your forms.

Use Our Online Portal

Email Your Forms

Parchment Office

Mid Towne Office

Fax Your Forms

Parchment Office

Mid Towne Office

Mail Your Forms

Parchment Office

Mid Towne Office

Our HIPAA Privacy Policy

In-Office Appointment Forms

New Patient Information

Adult History Form

Child History Form

Teletherapy Appointment Forms

For First Time Patients:

New Patient Information

Adult History Form

Child History Form

For Both Returning & New Patients:

Electronic Communication Authorization Form

Consent for Telepsychology Form

Kelly Culmore, DNP Patient Forms

Authorization Forms

Credit Card Authorization Form

Release of Information Form

Get The Help You Deserve. Contact Us.

Want To Join Our Professional Team?

Get In Touch:

Parchment Office:

Mid Towne Office:

Resources:

New Client:

Existing Client:

Authorization
Forms