Piedmont Psychiatric Clinic Piedmont Psychiatric Clinic Home


Prior to your first visit, you will be asked to complete some history forms.  These may be completed either in our office, or from your home.  The forms are available for download and listed below.

These forms are detailed and will enable us to gather the information we need in order to begin helping you right away.

All forms open in a new window and require Adobe Acrobat Reader (available here).

Form #2 - Patient Demographics

Form #3 - Personal History Questionnaire

Form #4 - Patient Symptoms Check List

Form #5 - History and Severity of Traumatic Events

Form #6 - Drug List

Form #7 Women of Child Bearing Age

Form #8 Consent for Treatment Use and Disclosure

Form #9 Patient Letter Regarding Insurance

Form #10 Full Office Policies and Procedures

Form #13 Short Office Policies and Procedures

Child Adolexcent Data Base Form

Parents Data Base Form

Explanation of Cancellation Policy