Forms & Documents

CALL US: 940-448-0304
FAX: 972-364-1189
1400 N Corinth St, Corinth TX, 76208

Our Counselors
Services
Resources
iChange Blog
Online Forms & Documents
FAQ
Contact Us

Forms below can be printed and filled out before your appointment to speed-up your check-in process. PDF reader required. Contact our office if you need assistance.

Documentation:

HIPAA Notice of Privacy Practices

Insurance Rights

Counseling forms:

Adult Intake Form

Child / Minor Intake Form

Psychiatry forms:

Adult Psychiatry Intake Form

Adult Psychiatry ROI

Telepsychiatry/ Teletherapy:

Telepsychiatry/ Teletherapy Informed Consent Form

Testing Forms:

Testing Intake Form

Make a payment online:

Schedule your appointment today.

Fill out and submit the form below and our staff will contact you during regular business hours.

Name *

First

Last

Phone *

Email *

Insurance Type

Enter CASH if paying cash

Treatment Type *

Notes/Comments

Comment

We do not share client information. We strive to keep information confidential and secure to the best of our abilities. Discretion is advised.

*We are not a 24hr crisis center.*
In case of emergency, please call 911 or see your nearest hospital.

iChange is open on an appointment basis only. We look forward to communicating with you in the next 24-48 business hours. If you do not receive a call or email within that time, please call iChange directly at
940-448-0304.