©2019 BY LEE MOORE, ARNP, PLLC dba SPECTRA INTEGRATIVE PSYCHIATRY

  • Facebook Social Icon

Patient Forms

It is required that you print, complete, and bring the following forms with you to your first appointment.  If you do not do so, you will need to complete these at the office and may be charged a fee and/or need to reschedule.

Feel free to print on both sides of the paper. 

Choose one of the below packets:

Adult (18+) intake packet

Child/Adolescent (<18) intake packet (coming soon)

Please note: individuals 13 years of age and older should fill the above packet out primarily on their own, with assistance from parents/guardians if requested.  Also, these packets contain a blank release of information (ROI) form; generally, you will want to complete that for any talk therapists, primary care providers, and recent psychiatric providers.  If any further ROIs might be useful, this can be discussed during your first appointment.

All patients will need the following forms:

Consent/policy forms

Individuals 13-17 years of age only will need the following form:

Treatment of minors

Additional forms (as needed):

Release of information

Credit card on file

Controlled substances agreement 

(Your provider will indicate if the above are needed.)