Patient Forms

The following forms and corresponding instructions have been provided for your convenience. Please note that these forms may not be the appropriate forms for all patients in all circumstances.

 

The first step in becoming a Cornerstone Mental Healthcare patient is to complete and submit the following forms*:

 

• INTAKE FORM

• KRISHAWNDA SCOTT - HIPAA NOTICE OF PRIVACY POLICIES AND PRACTICES

• CONSENT FOR TELEHEALTH SERVICES AND TREATMENT

• AUTHORIZATION FOR RELEASE/EXCHANGE OF INFORMATION

• BILLING AND FEES EXPLANATION

• CONSENT FOR TREATMENT AND POLICIES

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When downloading and printing these documents, please print single sided.

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Please contact the practice you wish to join if you have any questions. Completed forms can be emailed or mailed to us.

 

We look forward to seeing and caring for you!

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Cornerstone Mental Healthcare

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*Note this applies to the following CMH practice locations only: Colorado and Ohio.