New Client Forms

New Patient Paperwork

You will need Adobe Reader or another pdf reader to open the file. Note: To download Adobe Acrobat Reader for free, click here.

What to Bring to Your Appointment If You are a New Patient at JCCR

Picture ID
Insurance card
List of prescription medications and dosages
Current contact information
Emergency contact information
Any and all relevant Psychiatric records such as office/hospital notes

If you are scheduled for an initial evaluation, please click on the link below, print, fill it out to the best of your ability, and bring or mail the completed form for your first appointment.

JCCR RELEASE OF INFORMATION

ELECTRONIC COMMUNICATION/TELEMEDICINE CONSENT FORM

Patient Self Rated Form Paperwork

"Please note, these self-rated scales are not a substitute for a psychological or psychiatric evaluation and are not intended to diagnose or treat. They are designed to be used in conjunction with your treatment provider. If you do decide to complete any of the below scales, please review the results with your licensed mental treatment provider. If at any point you feel suicidal, homicidal, are hallucinating or feel that you may be a threat to yourself or others, please call 911 or visit your nearest Hospital Emergency Room." Please be aware that there will be no one to take your call if it is after hours or a non-business day including Sat., Sun and holidays. Please allow two business days for a response to any message left for the office.