Forms

Forms

NEW PATIENT FORM

Forms

Emergencies

Our emergency line, (336)-525-9090, is staffed 24/7 for current clients.
Forms

Treatment Agreement Form

Agreement to treatment with Mood Treatment Center
Forms

Controlled Substance Agreement

Forms

Med Visit Form

Complete before your visit. Or use printable version.
Forms

Med Visit Form (Child)

To complete before medication visits.
Forms

Therapy Visit Form

To complete before therapy appointments.
Forms

Teletherapy Consent Form

Agreement to therapy/counseling through telehealth
Forms

Disability

Request disability or FMLA forms.
Forms

Legal services

For clients who need us to provide testimony or consultation for legal purposes.
Forms

Release of Information

Authorize us to communicate with others on your behalf.
Forms

Request our records

Release our records to other parties.
Forms

Send records to us

Request that outside providers send records to us or communicate with us.
Forms

Pay bill

Forms

Update Demographics

Authorize us to communicate with your family or friends.
Forms

Feedback and Comments

Let us know how we can improve our services.