If you are seeking services for yourself, please fill out the INTAKE FORM and ADULT HISTORY FORM (below). Please submit these forms (Intake, History) online before your scheduled appointment, or if you prefer to fill them out by hand, please bring them with you. Finally, please download and read the HIPPA FORM and keep for your records.

If you are seeking services for a child (17 and under), please fill out the INTAKE FORM and CHILD HISTORY FORM (below). Please submit these forms (Intake, History) online before your scheduled appointment, or if you prefer to fill them out by hand, please bring them with you. To give our providers a comprehensive picture of your child's performance, please e-mail your child's teacher the link to the TEACHER FORM below and ask them to submit this before your appointment. Finally, please download and read the HIPPA FORM and keep for your records.

For Medicare beneficiaries only: Please fill out and sign our Medicare Opt-Out Patient Contract below.  As stated in our Intake Form below, The Nicholls Group does not provide Medicare or Medicaid services; therefore, if you are a Medicare or Medicaid beneficiary, please understand that the private contract below will need to be signed and you will be fully responsible for payment of all services provided.

If you have any questions, please call us at (480) 998-2303.


The following forms will open in a new window through RightSignature. 


Initial Appointment Forms to Complete:

Intake Consent Form (click here)

Child History Form (click here)

Adult History Form (click here)



Extra Office Forms:

Treatment of Minor Form (click here) (For adolescents whom are seeking therapy)

Records Release or Exchange of Records Form (click here)

Teacher Form (click here)

Adoption History Form (click here)

Medicare Opt-Out Patient Contract (Click Here)


Please Read/Review the HIPPA Privacy Terms Below:

2017 Psychologist - Patient Services Agreement - HIPPA Agreement