New Patient Forms

These forms are to be completed only after an initial appointment is scheduled. There may be additional forms specific to your insurance or EAP company that will need to be completed at your first appointment. Completed forms should be brought to your first appointment. If you are being seen via telehealth only, prior to your first appointment please mail the completed forms to: Baume Psychological Services, 12337 Hancock St., Suite 20, Carmel, IN 46032.

Required for all new patients

  • Social Security Number (SSN) not required for minors

  • Only last four of SSN required for an adult patient or an adult consenting on behalf of a minor

  • Insurance information not needed if already given to front office staff or provider

Required for patients seeing a master's level therapist

Only the signature page needs to be returned

Only complete the form that pertains

to your EAP benefits

Required for patients seeing a doctorate level psychologist

Only the signature page needs to be returned

Required for all patients during COVID-19

Only the signature page needs to be returned

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To Schedule An Initial Appointment

Call 317.706.6744