Patient Forms

New patients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, we provide the most important documents as downloads right here on our website.


Find out which forms you need to submit, select the appropriate download link and return the completed documents to our practice either in person, by fax or as a scanned PDF file via e-mail. Naturally, all forms are also available at the practice; however, filling them out in advance saves time.

If you are unsure which forms to fill out, don't hesitate to contact us.

New Patient Information Sheet
Contains essential patient information as it relates to treatment. Includes personal information, medical history and an emergency contact number.
TPS new patient information.pdf
Adobe Acrobat document [173.6 KB]
Authorization for Release of Medical Information
If you wish to authorize release of your medical information then please fill out and sign.
ROI pdf.pdf
Adobe Acrobat document [59.6 KB]
Written informed consent for telemedicine/telehealth
TELEMEDICINE informed consent fillable.p[...]
Adobe Acrobat document [84.4 KB]
Good Faith Estimate Notice
Right to a good faith estimate for expected charges for uninsured and self-pay patients.
Good Faith Estimate Notice.pdf
Adobe Acrobat document [43.4 KB]
Notice of Privacy Practices
Notice of Privacy Practices for Triangle Psychiatric Services, PA
privacy practices.pdf
Adobe Acrobat document [1.2 MB]

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.