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 Patient Ally, your patient portal.

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

Psychological Flexibility Measure

Passengers on the Bus

Sleep Hygiene


Relapse Prevention

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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