QYS
QYS
 

Patient Forms

New patients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, we provide the most important documents as downloads right here on our website.

 

Find out which forms you need to submit, select the appropriate download link and return the completed documents to our practice either in person, by fax or as a scanned PDF file via e-mail. Naturally, all forms are also available at the practice; however, filling them out in advance saves time.

If you are unsure which forms to fill out, don't hesitate to contact us.

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.

Services agreement
QYSClinicalagreementApril2014.doc
Microsoft Word document [47.5 KB]
Child/Youth Intake
ChildYouthhistoryform.doc
Microsoft Word document [46.0 KB]
Privacy Notice
PrivacyNotice2013.doc
Microsoft Word document [49.5 KB]
Adult Intake
Adultpersonalhistory.doc
Microsoft Word document [68.5 KB]

Where to Find Us

QYS Clinical Services

2240 North HWY 89 #C

Harrisville, UT 84404 

 

QYS Clinical Services North

19 West Center Street #201

Logan, UT 84321

 

QYS Clinical Services South

140 S. Main #2

Pleasant Grove, UT 84062

 

 

 

Central Intake:

877-393-6232

Email: admin@qyservices.com

 

 

Office Hours M-F 8am-6pm Weekends by appt. 1pm-6pm

Patient Forms

New patient? Save time and reduce the amount of paperwork you have to fill out at your first visit. We provide several patient forms as PDF downloads on our site.

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