Patient Forms & Resources

This page contains forms for new patients to download and complete as well as various informational resources for established patients. To download a page simply click on the title.  Please do not leave any comments or questions on this web page. All patient communication should be sent via our secure e-mail system.

Forms for New Patients

Please download only one of the New Patient Forms that corresponds to your insurance coverage.

1. Medicare [Traditional Medicare with or without a Supplement]

2. For Personal Choice, Keystone, Keystone-65 and other Independence BC Plans ONLY]

3.  For those with Aetna,  Blue PPO or POS, other insurance, or no insurance, ]

4. Presurgical Assessment Forms

5. Informed Consent for Telepsychology Services

6. Consent for Non-covered Service

Patient Resources

Mindfulness Therapy Manual

Stop – Look – Listen

Daily Assessment Form

ACT Matrix

ACT Choice Point


Valued Directions Worksheet

Values, Goals and Desire

Manipulative Communication and “I” Messages 

Cultivating Healthy Mind States 

“FACE COVID” – Responding Effectively to Corona Virus Crisis


Body Scan Meditation [MP3 Audio]

Breath Meditation [MP3 Audio]

Breath and Body Meditation [MP3 Audio]

Sitting Meditation [MP3 Audio]

Wave of Relaxation [MP3 Audio]

Mountain Meditation [Mp3 Audio]

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