Forms


Here are some forms to review before your first session. They can be completed on your computer and emailed to your clinician, or you can simply complete and print them and bring them into your first session. Please make sure to print off both your clinician’s consent form and the basic information form.

Dr. Sarah Bellefontaine Consent Form

Kellye Woods Consent Form

Kellye Woods EAP Treatment Consent Form – For Ceridian Clients

Please choose one of the following versions for our basic information form. The first lets you print and then fill it out by hand, the second allows you to fill it out using Microsoft Word, and then print it.

Printable PPCS basic information form

Form-Fillable PPCS basic information form

 

If you are a physician looking to refer a patient to our practice, please complete our Physician Referral Form or call us at (613) 843-8338.