Forms
Download and fill out these forms:

Benefits Verification Form...

Please return completed forms to us at your earliest convenience. You may fax to (904) 829-9768 or mail to

Psychological Services of St. Augustine
1100-1 South Ponce de Leon Blvd.
St. Augustine, FL 32084

You may also choose to hand-deliver forms to our office.

Forms are provided in PDF format. They require the Adobe Acrobat Reader.

If you have the Acrobat Reader version 8 or higher, you can fill in the form by typing into the fields provided, then email the completed form by clicking the provided "email" button, or you may print it out and fax/mail/hand-deliver it.

Email is NOT a secure form of communication. If you choose to email the completed form, you accept all responsibility for any privacy issues which may arise.

If you have the Acrobat Reader version 6 or higher, you can fill in the form by typing into the fields provided, then print the completed form, and fax/mail/hand-deliver it.

With older versions of Acrobat Reader or alternative PDF reader software, you can print the blank form, then fill it out normally and fax/mail/hand-deliver it.

If you do not have the Acrobat Reader, it is available as a free download from the Adobe Web Site...

Psychological Services of St. Augustine, Inc.

Main Office: 1100-1 South Ponce de Leon Boulevard, St. Augustine, Florida 32084
Phone (904) 824-7733 Fax (904) 829-9768

Southlake Office: 300 Kingsley Lake Dr, Suite 403 St Augustine, FL 32092

pssa@pssacare.com