Dr. Sharon Phillips, LLC
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Patient Forms

NEW PATIENTS: Please download the following forms, fill them out, and bring them with you to your first appointment.
For a new child/adolescent, the following forms need to be printed:
  • Insurance benefits worksheet
  • Child/adolescent demographic form
  • Child/adolescent assessment form
  • Outpatient services contract
  • HIPAA signature form
  • Consent to treat a minor
  • PCP form

For a new adult (18 and over), the following forms need to be printed:
  • Insurance benefits worksheet
  • Adult demographic form
  • Adult assessment form
  • Outpatient services contract
  • HIPAA signature form
  • PCP form
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The following form is for your review, but does not need to be printed out:
  • ​Two-way authorization to release information

For a new COLLABORATIVE LAW client, the following forms are for your review:
  • Collaborative Law Agreement
  • Collaborative Law Release of Information
  • Collaborative Law Client Information Form



Dr. Sharon Phillips, LLC
​Helping Families Navigate Life's Obstacles
​

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(513) 785-0831 | drsharonphillips@gmail.com
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