| FORMS |
| Please print the entire column of forms beneath the patient heading appropriate to the visit. Completed forms MUST be brought to the initial appointment. |
| ADULT Medical and Social History Personality Profile Adult ADHD Self-Report Mood Disorders Screen Cage & Scoff Screens Office Policy and Consent for Treatment |

| Stonebriar Psychiatric Services, P.A. 972-335-2430 |
| Those covered by Medicare will also need this form Medicare Private Contract |
Were you referred to our office by a medical professional or a counselor? If so, please download and complete the following form so that we can communicate with them. Be sure to initial all blanks and to sign the form. This form should also be completed for each previous psychiatrist, counselor or inpatient or residential facility you have had treatment from so that we can request records. Release of Information to Us |
| Couples - each partner should download and complete the following: Marital History Form Medical and Social History Personality Profile Adult ADHD Self-Report Mood Disorders Screen Cage & Scoff Screens Office Policy and Consent for Treatment |