Center for Psychological Services
Department of Psychology

Forms

Background Questionnaires

Clinicians often use these forms in the first session to gather some initial information. It is helpful if you can bring the form completed to your first session.

Child History & Background Questionnaire

Consent Forms

Our consent forms provide an overview of treatment and assessment services, as well as GMU CPS policies. Reviewing these forms will give you an idea of what you are agreeing to when you decide to seek services here.  It is a great idea to review these documents before your first session. 

Informed Consent 1

Informed Consent 2

Exchange of Information Form

The Exchange of Information Form is where you are able to provide permission for a GMU CPS provider to release/exchange information to or with another party. Due to client confidentiality, a signed copy of this form is required before we can exchange information about a client with another party.

Exchange of Information

Medical Record Request Form

To receive a copy of your medical record, print out and complete our request form below and mail, scan/email, or fax it to us. For your convenience, our contact information is included on the form.

 Medical Record Request Form

Financial Forms

Clients who wish to apply for a fee reduction based on our sliding scale fee schedule will need to complete the Financial Aid Request Form and return the form with supporting documentation. See the Payment & Insurance section of our site for more details on applying for a fee reduction.


Financial Aid Request Form

Credit Card Payment Setup

*To pay by Credit Card, click here.

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