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Marcy J. Gunn, Psy.D
Owner/Director of Child Psychology
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Jonathan M. Cleveland, Ph.D.
Director of Adult Psychology
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Chelsae Roby Pistello, Psy.D
Licensed Clinical Psychologist
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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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