Patient Forms
New patients will need to fill out forms before services can begin. To make the process as smooth and efficient as possible, Dr. Lenox provides access to forms on this website. Alternatively, you may arrive 15 minutes early to your first appointment to complete appropriate paperwork.
Please complete the appropriate intake form (child, college age, or adult), the business policy, and consent to exchange information form. To complete the forms, select the appropriate download link, print the form, complete it by hand, and bring the forms in person to your first appointment.
Business Policy
Please download, print, and bring the business policy to your first appointment.
Consent To Exchange Information
Authorization to exchange information with other sources.
Child and Adolescent Intake
This form is for patients ages preschool through high school.
College Student Intake
This form is for patients who are in college.
Adult Intake Icluding Business Policy
This form is for adult patients.
Financial Responsibility
This form is to be completed when the patient is not responsible for their therapy bills and a third party (e.g., parent of an adult patient, extended family member, etc) will be paying for treatment.
Credit Card Authorization
Complete this form to put a credit card on file to facilitate payment for therapy. This is especially helpful when a teenage patient drives themselves to therapy but their parents pay for services.