Innersense Behavioral Health
Evaluation, Therapy and Training
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Patient Forms

First review and download the forms to your right by clicking on them. Then, please print the forms, fill them out, and bring them to your appointment.

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Required Forms

To help optimze our time together, you will need complete several forms to bring with you at our first appointment. Please download, print, and complete the forms requested by us. Along with the Evaluation Form, there are a few other specific forms that will prove essential for us to properly take care of your needs. The Policy form is for your review purposes and yours to keep. Please call us if you have any questions about how to fill out your forms.

Patient Registration Form

View/Print form

Financial Policy Form

View/Print form

Privacy Policy Form

View/Print form

Patient Rights Policy

View/Print form

Cancellation Policy Form

View/Print form

You will need PDF software to open these documents. If you do not have PDF software you can obtain a free copy by going to Adobe.


Evaluation Forms

All our patienst need to complete one of the following forms:

Adult Evaluation Form

Patients 18 and older (except Dr. Narayan's patients) complete and bring to first appointment.

View/Print form

Child/Adolescent Evaluation Form

Patients 17 and younger: parents or guardians complete and bring to first appointment.

View/Print form

You will need PDF software to open these documents. If you do not have PDF software you can obtain a free copy by going to Adobe.