Intake Forms

Intake forms need to be completed by each new client at Western Reserve Psychological Associates, Inc., as well as former clients who are returning to the practice after a six month or longer absence.

Fill them out at least 24 hours before your first appointment.

To access our patient portal, please contact our office with your email address and request a welcome email. Click the link in the shaded box of the welcome email you received. You will be asked to create your own password-protected account on the portal.

If the patient is under the age of 18, you will need to complete the following forms:

• Notice of Privacy Practices
• Statement of Understanding
• Signature Page
• Telepsychology Informed Consent
• Severity Measures – Child (11-17)
• Child-Adolescent Intake
• Consent to Treat a Minor

If the patient is 18 years of age or older, you will need to complete the following forms:

• Notice of Privacy Practices
• Statement of Understanding
• Signature Page
• Telepsychology Informed Consent
• Adult Intake
• Severity Measures – Adult
• Consent to Treat an Adult

If you are between the ages of 18 and 26 and are using your parents’ insurance, you will also need to complete this form for billing purposes only:

• Auth Exchange Info with Parents

If you will be seen in the office, you will need to complete the following form:

• In-Person Informed Consent

Once you have established your account in Updox, you may access it at any time with this link:

https://myupdox.com/portal/www.westernreservepsych.com/html/index.html