Patient Information

Forms

Prior to you initial appointment please fill out registration paperwork. If you do not have access to a printer copies of the paperwork are available in the office. For those filling out paperwork in the office, please come 15-20 minutes early to allow adequate time to complete the forms prior to your appointment.

Individuals pursuing couples therapy must each fill out registration forms.

If any questions should arise, call the front desk at 262.241.7778 for assistance.

Registration Forms:

Adult Registration Forms

Child Registration Forms

Spravato Benefit Investigation Consent

Spravato Registration Forms

Release Form:

Authorization for Release of Information Form

Screening Tools:

Depression

Mood Disorder Questionnaire

ADHD (18+)

Alcohol

Patient Resources

Resources Guide

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Mequon Clinical Associates is continuing to see patients. *Update as of 5/13