Welcome to the portal for Psychology Associates of Grand Rapids forms.

The forms provided here are for the use of Psychology Associates of Grand Rapids patient and staff only. Your privacy is our number one concern and any information provided by you through this site is protected by industry-standard encryption and subject to our privacy policy. By filling out forms on our site you agree to the statements in our privacy policy. You can view our privacy policy by clicking here.

If you have a teletherapy appointment, please fill out the forms below:

• Informed Consent for Telepsychology
• Client Authorization for Disclosure of Protected Health Information Via Electronic Communication
• If you are a new patient please also fill out:
  • New Client Information – Parchment
  • New Patient Info (Adult)
  • New Patient Info (Child – Parent, please complete)

If your appointment is at our Parchment Office please fill out the appropriate forms listed below:

• New Client Information – Parchment **REQUIRED**
• New Patient History Form Parchment – Adult
• New Patient History Form Parchment – Child (Parent please complete)
• HIPAA Privacy Policy (For your review)

If your appointment is at our Mid Towne Office, please fill out all the appropriate forms listed below:

• New Client Information – Mid Towne **REQUIRED**
• New Patient History Form Mid Towne – Adult
• New Patient History Form Mid Towne – Child (Parent please complete)
• HIPAA Privacy Policy (For your review)

If you are scheduled to see John Michell, MD please fill out the forms listed below:

• New Client Form – John Mitchell, MD
• Medication Visit Form – Please complete before each medication visit

Authorization Forms

• Credit Card Authorization Form
• Release of Information Form