The Center for Hope
The Center for Hope               

Patient Forms & Patient Portal

New patients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, we provide the most important documents as downloads right here on our website.

 

Find out which forms you need to submit, select the appropriate download link and return the completed documents to our practice either in person, by fax or as a scanned PDF file via e-mail. Naturally, all forms are also available at the practice; however, filling them out in advance saves time.

 

**If you are asked to log on to the patient portal through simple practice, you may do so through the following link here:  https://monica-blume.clientsecure.me

Please Print and fill out the following form(s):

New Patient Forms
Client New Patient Form.pdf
Adobe Acrobat document [2.0 MB]

These Documents are required only if your Clinician asks you to fill them out.

Client History & Information
Client History and Information.pdf
Adobe Acrobat document [650.3 KB]
Client Substance Abuse History
Substance Abuse History.pdf
Adobe Acrobat document [89.0 KB]
Client Payment Forms - Private Pay
Client Payment Forms - Bishop.pdf
Adobe Acrobat document [166.3 KB]

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.

Please call to schedule an appointment: 801.361.0982

Where to Find Us:

Springville Office:

1220 N. Main Street #11

Springville, UT 84663

 

Sandy Office:

9160 S. 300 W. #16

Sandy, UT 84070

monicalblume@gmail.com

 

 

 

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© Monica L. Blume, LCSW