Prior to your first appointment, please print and complete the required forms.
Bring the signed forms along with your ID and insurance card(s).
Print the form packet, which includes the following forms:
- Welcome to MHMR Tarrant Letter
(it is not necessary to return this letter to clinic)
- Acknowledgement of Receipt of Welcome Packet
- Personal Information
- Assignment of Benefits
- Medical History - Review of System Form
- MHMR of Tarrant County Notice of Privacy Practices
(it is not necessary to return this notice to clinic)
- Acknowledgement Receipt of Notice of Privacy Practices
- Consent for Treatment
- Child/Adolescent Intake
- Guidelines Regarding Triplicate Prescriptions (RX)
If your child is being assessed for an Attention Deficient Hyperactivity Disorder (ADHD) diagnosis, please print and bring these additional forms.
Fill out the Parent Rating Scale Form and have a teacher fill out the Teacher Rating Scale Form.
Additional Information Needed:
- Picture Identification Card(s)
- Insurance Card(s)