Forms - Hearts and Minds Services

Welcome to Hearts and Minds Healthcare Services

Thank you for choosing Hearts and Minds Healthcare Services for your mental health needs! In order to provide you with the best care possible, please complete the new patient forms within 48 hours of scheduling your appointment.

Please also provide a copy of your Insurance Card and a form of ID to our email support@heartsandmindspllc.com.

If you have any questions or concerns about the forms, please do not hesitate to contact us at support@heartsandmindspllc.com or call (717) 739-9172.

How to Submit Your Forms

Download and complete all required forms
Scan or take clear photos of your completed forms
Email the forms along with your Insurance Card and ID to support@heartsandmindspllc.com

Required Forms

HAM ADULT ADHD SELF-REPORT SCALE Patient Health Questionnaire Generalized Anxiety Disorder (GAD–7) Scale Mood Disorder Questionnaire

Need Professional Support?

(717) 739-9172

Schedule Appointment