Now accepting registration for Psychiatry and Medication Management

Santa Rosa Counseling Center
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Santa Rosa Counseling Center
  • Home
  • Services
  • Clinicians
  • Forms
  • TherapyPortal
  • Contact
  • For Couples

Registration Forms

Please print and bring completed forms to your first session.

 Complete an Authorization for Release of Information form for all medical providers.

New Patient Registration Packet (pdf)Download
Informed Consent (pdf)Download
Financial Policy (pdf)Download
Authorization for Release of Information (pdf)Download
Controlled Substance Agreement (pdf)Download
HIPAA Notice of Privacy Practices (pdf)Download

Miscellaneous

Referral (pdf)Download
Sliding Fee Schedule Program (pdf)Download

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