Forms For Existing Patients

At Specialty Clinic of Austin, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax us your printed and completed forms or you may bring them during your visit.

Release of Information

This form permits Specialty Clinic of Austin to send or receive your medical records to or from another provider. It also permits Specialty Clinic of Austin to discuss or share confidential information with a person you designate (e.g., a family member, your psychotherapist, or another caregiver).

Click here to complete and submit a Release of Information form via our secure online service. Click here to download a PDF version of this form.

Consent Form for the Treatment of Minors with Divorced or Separated Parents

This form permits Specialty Clinic of Austin clinicians to initiate treatment for minors of divorced or separated parents. It must be signed by any parents or legal guardians who are listed in the custodial agreement prior to the initiation of psychiatric treatment.

Click here to print a PDF version of this form. Please bring the completed form to your child’s intake appointment.

Clinic Policies, Controlled Substances Agreement and Notice of Privacy Practices

These forms are part of your new patient paperwork but are available here in PDF version for your records. Our staff will also provide you a copy of your signed paperwork per your request.

Click links below to print PDF versions of these forms:

Office Policies & Procedures (PDF)
Controlled Substances Form (PDF)
Notice of Privacy Practices (PDF)

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