Patient Forms

In order to save you time in our offices, Elizabeth Ann Smith LCSW, ACSW in Scottsdale, AZ is happy to provide some of our patient forms online. Simply download the forms below, fill them out in advance and bring them in to your appointment, so we can get started right away. If you have any questions, contact our office for more information.

Consent and Text Form
Consent from client to text and email regarding appointments.

Client Consent to Charge Copays and for Missed Appointment Without 24 Hour Notice
Client signature and credit card info with consent to charge copays and missed appointments without 24 hour notice.

On Track Outcomes
Client evaluation of therapist (client feedback form).

Standard Release Of Information
Client signature needed for release of information.

Intake Forms
Intake forms, please read and sign.

Consent To See Child/Adolescent For Psychotherapy
Parents’ signatures needed and date before initial session.

Social Media Policy for Informed Consent Clients
Signature and date for informed consent.

Consent for charts release

Updated form for Telehealth

Contact Us

Elizabeth Ann Smith LCSW, ACSW

7702 East Doubletree Ranch Road, Suite 300, Scottsdale, AZ 85258 | Phone: 480-294-4581480-294-4581

Business Hours:
Monday – Saturday: 9:00 AM - 5:00 PM | Early Evening and Early Morning Appointments Are Negotiable

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