Intake Paperwork

This is a downloadable and printable version of your required intake paperwork. Please complete all forms before your scheduled session, as completed intake paperwork is required before your session can begin.

If you prefer to complete your intake paperwork electronically on a mobile device or computer, please call or text us at 931-274-7588.

If completing the printable version, please bring your completed paperwork with you to your appointment and be prepared to provide it to your clinician or an available administrative staff member.

Medical Records Request

A Medical Records Request is a request for a copy of some or all of the records maintained by your provider regarding your care. Medical records may include evaluations, treatment information, diagnoses, and other clinical documentation, depending on the type of records requested.

This form allows you to tell us which records you are requesting, why you need them, and how you would like to receive them. You may request records for yourself or, when legally authorized, on behalf of another person.

Please provide complete and accurate information so we can process your request. Processing may take a reasonable amount of time, including up to 10 business days, and fees may apply as permitted by law.

Medical records may contain private or sensitive information. Once records are released to you or another authorized recipient, they may no longer be protected by the same privacy laws.

Sliding Scale Form

This form is for individuals who do not want to use insurance or do not have insurance and believe the self pay rates are unaffordable. The form requires information about household size and income to see if an individual qualifies for a reduced rate and the amount of the reduced rate for services.