New Patients Forms

Choose the appropriate form below and bring completed to your first appointment. Please plan to arrive ten minutes early to complete the registration process.

All co-pays, co-insurance, and deductible amounts are due at the time of service. Dean Aman, LPCMH LLC reserves the right to cancel appointments if payments are not made prior to the appointment. For more information on payments, visit our FAQ page.  

24 hour notice is required to cancel an appointment. If 24 notice is not given, a missed appointment fee will be incurred. Returned checks or declined credit cards will be charged a $40 service fee.  

Adult

Child

 

Short-Term Disability

Tele-psychiatry