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Marcy J. Gunn, Psy.D
Owner/Director of Child Psychology
Jonathan M. Cleveland, Ph.D.
Director of Adult Psychology
Chelsae Roby Pistello, Psy.D
Licensed Clinical Psychologist
FORMS
Downloadable Application Forms
Adult Background Form
Authorization Form
Child Background Form
Contact Consent
Demographic Form for Insurance
HIPAA Release
Notice of Privacy Practices
Welcome Letter
CUXOS Form
Authorization Form - School
CUDOS
Client Rights and Responsibilities
Credit Card Explanation
Financial Agreement Form
Informed Consent
Patient Rights and Responsibilities
Card on File Authorization Form
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