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Melody Fortenberry, Ph.D, LMFT

Therapy for Adults, Children, Couples, & Families

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Forms

Fill in Prior to First Visit:

Information Form for Adult Patients

Information Form for Children - to be Completed by Parent

Fees, Office Policies and Procedures

Notice of Privacy Practices

Other Forms:

Background Questionnaire for Adult Patients

Background Questionnaire for Children - to be completed by Parent

Background Questionnaire for Adolescents

Authorization for Dr. Fortenberry to release records

Authorization for a third party to release records to Dr. Fortenberry

Schedule Appointment

Start your new path in life and be the change today!

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Helpful Forms

Click here to view and print forms for your appointment.

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Melody Fortenberry, Ph.D.
(972) 458-9890
6750 Hillcrest Plaza Drive
Suite 314
Dallas, Texas 75230

[email protected]


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