Patient Forms

To help make your first visit smoother and more efficient, we’ve provided the necessary forms for you to complete ahead of your appointment.

Establishment of Care and Patient Eligibility

ThriveLine: Telepsychiatry & Mental Wellness, PLLC offers psychiatric evaluations, diagnosis, and medication management for adults seeking collaborative, trauma-informed care.

Important: Submitting intake forms, requesting an appointment, or attending an initial evaluation does not establish a patient–provider relationship.

The initial evaluation determines whether ThriveLine’s outpatient telepsychiatry is clinically appropriate and sustainable for your needs. A formal treatment relationship begins only if both you and the provider agree to proceed after the evaluation.

Pre-Evaluation Review: When possible, I review intake forms before scheduling to assess whether your needs align with the care I can safely provide. If another setting is more appropriate, I’ll notify you and may offer general guidance to help avoid unnecessary cost, time, or emotional strain.

If new information arises during the evaluation or circumstances change, and ThriveLine is no longer a suitable option, I’ll discuss alternatives and share community resources.

Coordination of Care (If Needed): If a higher or more structured level of care is indicated, I can—with your consent—forward the evaluation to another provider to support a safe and informed transition.

ThriveLine does not assume clinical responsibility for individuals not formally accepted into treatment.

This policy prioritizes your safety. Starting care in a setting that cannot meet your needs would undermine your recovery and conflict with ThriveLine’s mission: helping you move from surviving to thriving.

Patient Forms

Insurance & Secure ID Intake Packet

Release of Information Consent

Patient Demographic Intake Packet

Financial Responsibility, Services & Administrative Policy

Establishment of Care and Patient Eligibility