Patient Forms

Embarking on a journey towards wellness should be as seamless as possible. We’ve simplified the initial steps of this journey by providing easily accessible patient forms on our website. To facilitate a smooth and efficient onboarding process, kindly ensure all necessary forms are completed and submitted promptly.

• PTSD Checklist Adult
• Insomnia Severity Index
• Patient Registration Forms:
  • Patient Registration Form
  • PHQ-9 Depression Assessment Form
  • Generalized Anxiety Disorder 7-item (GAD-7) Scale
  • Adult ADHD Self-Report Scale (ASRS-V I. I) Symptom Checklist
  • Mood Disorder Questionnaire Screener
• Controlled Substance Form
• Notice of Privacy Practices
• Patient Information Consent and Financial Policy
• Intake Form
• Release Receive
• Termination Policy
• Self Pay Agreement
• Screening Form
• Initial Evaluation Form
• Telehealth Services Informed Consent Form
• MAJ Comprehensive Wellness Center LLC Medication Consent Form
• MAJ Comprehensive Wellness Center LLC Signed Medication Consent Form