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Beacon Psychology Services LLC; 11495 N. Pennsylvania, Suite 105; Carmel, IN 46032
(317) 942-4020
© 2020 Beacon Psychology Services LLC
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You can download a free one HERE.
Please print out and complete these two forms for your child's first appointment, or click the Online Registration button:
Youth Background Information
Youth Registration
Teacher Information Form
(not needed for your initial appointment)
If there are school-based issues, please print out this form and have your child's teacher complete:
This form gives your consent for us to communicate with specific agencies/individuals regarding our services to you:
Release of Information
(not needed for your initial appointment)
General Information:
Privacy Polices
(Both forms as well as Telehealth Consent form are combined
for online registration)
If you are an 18 or over, please print and complete these two forms for your first appointment.
Adult Registration
Adult Background
If you wish to have a session via phone, Facetime, etc., please print and fill out this form or click the Online Form button:
Telehealth Consent
OR
For Online Form
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Beacon Psychology Services
"Lighting the Path to Full Potential"
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