Louisville's first and
only immediate mental
healthcare center.

502.414.4557 Schedule Online

Forms

For New Patients:

1. Authorization to Release Information– Your privacy and confidentiality are very important to us. However, there may be some people– such as spouses, doctors, therapists, or disability agents– that you may want us to speak with. The names of those individuals should be included in these forms.

2. Health History Questionnaire.– Because our clinicians sometimes prescribe medication, knowing your medical history helps us know what treatment options are appropriate for you.