Forms and Patient Portal Access

Access your Patient Portal

The patient portal can used to submit a medication refill request, pay balances, view upcoming appointments and more!

New Patient Intake Form

Please fill out this form if you would like to become a new patient with us. If you are unsure whether or not we accept your insurance, please contact our office and we will be happy to find out for you.

*We do not accept any Medicaid policies. If you have Aetna, Cigna, United Healthcare, or other commercial plans we could see you for a self-pay rate*

Psychotherapy Informed Consent

Therapy-Only New Client Paperwork

Sliding Scale Fee Application


Permission To Release Info

Patient Policies

Medication Refill Request

In order to submit a medication refill request you will need to do so through your patient portal. If you do not have a patient portal, please call or text our office. One of our representatives will help you get your patient portal set up and direct you on what you will need to do.

Administrative Forms


Get in contact with a professional at Hagan Health.