Clinical Psychologist | Licensed in Oklahoma & Arkansas | Tulsa, Oklahoma

Forms

PLEASE NOTE: If you previously spoke to Dr. Mattox and she instructed you to look for forms here, please call the office with an email address.  The office is using a different process now to provide paperwork, as of 8/28/2021.

 

New Patient Paperwork – Each new patient will need to complete a total of 3 forms as follows, and bring them to the first appointment.  Dr. Mattox will email the new patient paperwork to you for completion.  DO NOT EMAIL THE COMPLETED FORMS BACK TO THE OFFICE.

1.  All patients must complete the General Office Forms packet

2.  Consent Forms – All new patients must complete either the Testing/Evaluation Consent Form or the Treatment Consent Form , depending on which service you will be receiving.

3.  Patient History Forms – All new patients must complete either the Adult History Form or the Child/Adolescent History Form.

 

In addition to the completed paperwork, please bring the following to your first appointment:

  1. New patient paperwork (see above)
  2. Your insurance card (if you want me to bill insurance on your behalf)
  3. A photograph of the patient – this will stay in the chart

 

Other Forms – These forms are not needed at the first appointment, but may be needed later.

If you have previously provided information that has now changed, please use one of the following forms to update your information.  Please note these are NOT needed for new patients:

Updated Contact and Insurance Information – Adult Client

Updated Contact and Insurance Information – Child/Adolescent Client

If you need Dr. Mattox to release information to any other entity (school, physician, other treatment provider, etc.) or want to give permission for Dr. Mattox to speak to any other person about the patient, please complete the following form:

Authorization to Release Client Information

If you wish to have a remote, virtual telepsychology session, the following form is required to be completed and on file.  Please understand that Dr. Mattox will decide whether a telepsychology session is appropriate for what you are requesting.

Telepsychology Informed Consent

  • Issues Commonly Addressed

    • Anxiety & Tic Disorders
    • Autism/Asperger's
    • Developmental Disorders
    • ADHD
    • Learning disabilities
    • Challenging behavior
    • Poor social skills
    • Problematic family functioning